Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 11775524 | UT |
NPI | 1285085480 |
---|---|
Provider Name | Dr. Cameron Bishop Leavitt |
First Address | St George, UT 84790-1762 |
Second Address | St George, UT 84790-1762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 14/07/2020 |