| Doctor Name: | DR. GLENN RALPH LEAVITT |
| NPI Number: | 1386644318 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | O-0365 |
| Business Practice Address: | 1550 Elk Crk Idaho Falls, ID - 834048322 |
| Business Phone Number: | 2085295942 |
| Business Fax Number: | 2085295951 |
| Mailing Address: | 1550 Elk Crk, IDAHO FALLS |
| State: | ID |
| Postal Code: | 834048322 |
| Phone Number: | 2085354580 |
| Fax Number: | |
| NPI Enumeration Date: | 08/01/2005 |
| NPI Last Update Date: | 03/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | O-0365 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |