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1184810590

NPI Code Detail

MEDICARE: MATTHEW O LEAVITT MD

MEDICARE: MATTHEW O LEAVITT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0500X	Cytopathology Physician	65908671205	UT
2	207ZD0900X	Dermatopathology (Pathology) Physician	65908671205	UT
3	207ZI0100X	Immunopathology Physician	65908671205	UT
4	207ZN0500X	Neuropathology Physician	65908671205	UT
5	207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	65908671205	UT
6	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	65908671205	UT
7	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	65908671205	UT

General Provider Information

NPI Number	:	1184810590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW O LEAVITT MD

Provider Business Mailing Address
First Line	:	5100 TALLEY RD STE 300
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-8040
Country	:	US
Telephone Number	:	15-006-7675
Fax Number	:	801-225-5623

Provider Business Practice Location Address
First Line	:	5100 TALLEY RD STE 300
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72204-8040
Country	:	US
Telephone Number	:	15-006-7675
Fax Number	:	801-225-5623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	06/16/2021

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Directions to “ MATTHEW O LEAVITT MD” Practice Location

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