Provider Demographics
NPI:1528701554
Name:LEAVITT, TAYLOR DEAN (MD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:DEAN
Last Name:LEAVITT
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 1:18703 CREEK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-5289
Mailing Address - Country:US
Mailing Address - Phone:208-989-1040
Mailing Address - Fax:
Practice Address - Street 1:3038 BLUE JAY LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-8704
Practice Address - Country:US
Practice Address - Phone:208-989-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10030398207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology