Provider Demographics
NPI:1972523942
Name:LEONARD, LARRY GIVENS (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:GIVENS
Last Name:LEONARD
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 1:15 MARIE COURT
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6618
Mailing Address - Country:US
Mailing Address - Phone:406-581-8852
Mailing Address - Fax:
Practice Address - Street 1:15 MARIE COURT
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6618
Practice Address - Country:US
Practice Address - Phone:406-581-8852
Practice Address - Fax:406-219-0193
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC63465Medicare UPIN