Provider Demographics
NPI:1649368275
Name:MARVIN, LEIGH J (MD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:J
Last Name:MARVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-0512
Mailing Address - Country:US
Mailing Address - Phone:913-592-3548
Mailing Address - Fax:
Practice Address - Street 1:6501 E COMMERCE AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64120-2171
Practice Address - Country:US
Practice Address - Phone:816-561-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25447207Q00000X
AZ55198207Q00000X
WI21-320207Q00000X
UT10533313-1205207Q00000X
IL036144429207Q00000X
IAMD-44657207Q00000X
COCDR.0000038207Q00000X
TXR8421207Q00000X
MN63140207Q00000X
WV27902207Q00000X
MS25367207Q00000X
MTMED-PHYS-LIC-60456207Q00000X
NV17499207Q00000X
WY11173C207Q00000X
MO2006024762207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
39952Medicare UPIN