BRENT LEAVITT

CHUBBUCK, ID
NPI1740650548
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-1299)
Enumeration Date2015-10-06
Last Update Date2015-10-06
Business Address
-- BRENT LEAVITT
4928 PLEASANT VIEW DR
CHUBBUCK, ID 83202-1640
Phone number: 208-760-9416
Mailing Address
-- BRENT LEAVITT
4928 PLEASANT VIEW DR
CHUBBUCK, ID 83202-1640
Phone number: 208-760-9416
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