Doctor Name: | SHANE COLBY LEAVIT |
NPI Number: | 1942417811 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0116016876 |
Business Practice Address: | 3726 Broadway, Suite 201 Everett, WA - 98201 |
Business Phone Number: | 4253179119 |
Business Fax Number: | 4253179118 |
Mailing Address: | 3726 Broadway,, Suite 201 EVERETT |
State: | WA |
Postal Code: | 98201 |
Phone Number: | 4253179119 |
Fax Number: | 4253179118 |
NPI Enumeration Date: | 05/17/2007 |
NPI Last Update Date: | 04/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 0116016876 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | VA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |