Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036088511 | IL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036088511 | IL |
NPI | 1225069057 |
---|---|
Provider Name | Darr W Leutz |
First Address | Quincy, IL 62301-2834 |
Second Address | Quincy, IL 62305-5875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 07/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036088511 | (05) | IL |