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General NPI Number Information
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NPI Number | 1992092894
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Entity Type | Individual
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Provider Name | JOSHUA DAHL LEAVITT DPM
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Gender | Male
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 2308 96 ST NW
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City | EDMONTON
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State | AB
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Zip | T6N 1J8
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Country | CA
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Telephone | 877-444-3668
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Fax |
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Provider Business Mailing Address
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Address Line | BOX 657 CARDSTON AB T0K0K0
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City | CARDSTON
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State | ALBERTA
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Zip | T0K0K0
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Country | CA
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Telephone | 403-653-2877
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC006294
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License Number State | PA
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