Provider Demographics
NPI:1285085480
Name:LEAVITT, CAMERON BISHOP (DO)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:BISHOP
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 S 1470 E # 200
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1762
Mailing Address - Country:US
Mailing Address - Phone:435-628-1662
Mailing Address - Fax:435-628-1722
Practice Address - Street 1:295 S 1470 E # 200
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1762
Practice Address - Country:US
Practice Address - Phone:435-628-1662
Practice Address - Fax:435-628-1722
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT017448390200000X
UT11775524207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program