Healthcare Provider Details

I. General information

NPI: 1427378298
Provider Name (Legal Business Name): DAVID ALAN LEITMAN II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 DUNN RD
SAINT LOUIS MO
63136-6163
US

IV. Provider business mailing address

896 CYPRESS TRL
O FALLON MO
63368-8297
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5000
  • Fax:
Mailing address:
  • Phone: 636-485-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: