Healthcare Provider Details

I. General information

NPI: 1104113190
Provider Name (Legal Business Name): JULIE D. LEYZOREK HARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE D HARE MD

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DUNCAN ROAD
BUCKEYE WV
24924-9037
US

IV. Provider business mailing address

150 DUNCAN ROAD
BUCKEYE WV
24924-9037
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-7400
  • Fax: 304-799-2276
Mailing address:
  • Phone: 304-799-7400
  • Fax: 304-799-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25895
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: