MEDICARE: TRENT LEAVITT D.O.

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	208000000X	Pediatrics Physician	125065536	IL
2	207R00000X	Internal Medicine Physician	125065536	IL
3	207R00000X	Internal Medicine Physician	DO3009	NV

General Provider Information

NPI Number	:	1215341938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRENT LEAVITT D.O.

Provider Business Mailing Address
First Line	:	2370 CORPORATE CIR STE 300
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7760
Country	:	US
Telephone Number	:	702-910-3950
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 BUSINESS PARK CT STE 130A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9007
Country	:	US
Telephone Number	:	702-844-4848
Fax Number	:	702-844-4849

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

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	01/30/2023

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Directions to “ TRENT LEAVITT D.O.” Practice Location

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