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NPI Code Detail

MEDICARE: VAN STEPHEN LEAVITT D.O.

MEDICARE: VAN STEPHEN LEAVITT D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician006665AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780976480
Entity Type Code : Individual
Provider Name (Legal Business Name) : VAN STEPHEN LEAVITT D.O.
Provider Business Mailing Address
First Line : PO BOX 33269
Second Line :
City : PHOENIX
State : AZ
Zip : 85067-3269
Country : US
Telephone Number : 602-406-4786
Fax Number : 916-636-4358
Provider Business Practice Location Address
First Line : 3477 S MERCY RD STE 208
Second Line :
City : GILBERT
State : AZ
Zip : 85297-0448
Country : US
Telephone Number : 480-728-6590
Fax Number : 480-728-6591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2011
Last Update Date : 08/05/2025

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Directions to “ VAN STEPHEN LEAVITT D.O.” Practice Location

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