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General NPI Number Information
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NPI Number | 1528701554
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Entity Type | Individual
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Provider Name | TAYLOR DEAN LEAVITT MD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 3038 BLUE JAY LN
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-8704
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Country | US
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Telephone | 208-989-1040
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Fax |
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Provider Business Mailing Address
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Address Line | 18703 CREEK FOREST DR
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City | MANVEL
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State | TX
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Zip | 77578-5289
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Country | US
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Telephone | 208-989-1040
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | BP10030398
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License Number State | TX
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