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General NPI Number Information
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NPI Number | 1679550677
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Entity Type | Individual
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Provider Name | LEONARD WILLIAM DUVALL PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 480 CENTRAL AVE NAVAL HEALTH CLINIC
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City | PEARL HARBOR
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State | HI
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Zip | 96860-4908
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Country | US
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Telephone | 808-474-0625
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Fax |
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Provider Business Mailing Address
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Address Line | 95-2075 PUUKAA ST
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City | MILILANI
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State | HI
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Zip | 96789-6510
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 104
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License Number State | HI
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