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NPI Code Detail

MEDICARE: RICHARD VAN LEEUWEN M.D.

MEDICARE: RICHARD VAN LEEUWEN M.D.
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
1207Y00000XOtolaryngology Physician6474961-1205UT

General Provider Information

NPI Number : 1871584482
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD VAN LEEUWEN M.D.
Provider Business Mailing Address
First Line : PO BOX 337
Second Line :
City : LAYTON
State : UT
Zip : 84041-0337
Country : US
Telephone Number : 801-773-4840
Fax Number :
Provider Business Practice Location Address
First Line : 2121 N 1700 W
Second Line :
City : LAYTON
State : UT
Zip : 84041-8803
Country : US
Telephone Number : 801-773-4840
Fax Number : 801-525-8179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 07/21/2022

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