Provider Demographics
NPI:1992092894
Name:LEAVITT, JOSHUA DAHL (DPM)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:DAHL
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 657 CARDSTON AB T0K0K0
Mailing Address - Street 2:
Mailing Address - City:CARDSTON
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T0K0K0
Mailing Address - Country:CA
Mailing Address - Phone:403-653-2877
Mailing Address - Fax:
Practice Address - Street 1:2308 96 ST NW
Practice Address - Street 2:
Practice Address - City:EDMONTON
Practice Address - State:AB
Practice Address - Zip Code:T6N 1J8
Practice Address - Country:CA
Practice Address - Phone:877-444-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006294213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist