Healthcare Provider Details

I. General information

NPI: 1538235569
Provider Name (Legal Business Name): ANDREW CLARK LEAVITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S KANNER HWY STE 300
STUART FL
34994-4801
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-5881
  • Fax: 772-223-5996
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0056754
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME0056754
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME0056754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: