Provider Demographics
NPI:1104113190
Name:LEYZOREK HARE, JULIE D (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:D
Last Name:LEYZOREK HARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:D
Other - Last Name:HARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 DUNCAN ROAD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:WV
Mailing Address - Zip Code:24924-9037
Mailing Address - Country:US
Mailing Address - Phone:304-799-7400
Mailing Address - Fax:304-799-2276
Practice Address - Street 1:150 DUNCAN ROAD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:WV
Practice Address - Zip Code:24924-9037
Practice Address - Country:US
Practice Address - Phone:304-799-7400
Practice Address - Fax:304-799-2276
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA207Q00000XOtherFAMILY MEDICINE