Provider Demographics
NPI:1376549329
Name:LEAVITT, ERIC B (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:B
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 N. MCDONALD ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1088
Mailing Address - Country:US
Mailing Address - Phone:509-928-7272
Mailing Address - Fax:509-928-7346
Practice Address - Street 1:1424 N. MCDONALD ROAD
Practice Address - Street 2:STE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1088
Practice Address - Country:US
Practice Address - Phone:509-928-7272
Practice Address - Fax:509-928-7346
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029327207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8919359OtherCRIME VICTIMS
WA8139495Medicaid
WA44031OtherLABOR & INDUSTRIES
WAF31267Medicare UPIN
WA8139495Medicaid
WAG000349703Medicare PIN