Provider Demographics
NPI:1184810590
Name:LEAVITT, MATTHEW O (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:O
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5100 TALLEY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8040
Mailing Address - Country:US
Mailing Address - Phone:015-006-7675
Mailing Address - Fax:801-225-5623
Practice Address - Street 1:5100 TALLEY RD STE 300
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8040
Practice Address - Country:US
Practice Address - Phone:015-006-7675
Practice Address - Fax:801-225-5623
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2021-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT65908671205207ZC0500X, 207ZD0900X, 207ZI0100X, 207ZN0500X, 207ZP0007X, 207ZP0105X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063500Medicare PIN