MEDICARE: DR. RONALD 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	207X00000X	Orthopaedic Surgery Physician	21597	CT
2	207XS0106X	Orthopaedic Hand Surgery Physician	21597	CT
3	207XS0106X	Orthopaedic Hand Surgery Physician	042-0011868	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629059738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD LEAVITT MD

Provider Business Mailing Address
First Line	:	12670 CREEKSIDE LN
Second Line	:	SUITE 202
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3370
Country	:	US
Telephone Number	:	239-482-2663
Fax Number	:

Provider Business Practice Location Address
First Line	:	12670 CREEKSIDE LN
Second Line	:	SUITE 202
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3370
Country	:	US
Telephone Number	:	239-482-2663
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	02/25/2013

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Directions to “ DR. RONALD LEAVITT MD” Practice Location

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