Provider Demographics
NPI:1942353800
Name:RASMUSSEN, LEIF (MD)
Entity Type:Individual
Prefix:DR
First Name:LEIF
Middle Name:
Last Name:RASMUSSEN
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:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947-1058
Mailing Address - Country:US
Mailing Address - Phone:530-284-6135
Mailing Address - Fax:530-284-7594
Practice Address - Street 1:410 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:CA
Practice Address - Zip Code:95947
Practice Address - Country:US
Practice Address - Phone:530-284-6135
Practice Address - Fax:530-284-7594
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine