Bruce Norman Leistikow, MD

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

G80992 Issued in CA

Practice address

1 Shields Ave
Davis, CA 95616-5270

Phone

(530) 752-1011

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360886400000",
    "number": "1265449169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3410 MONTE VISTA AVE",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956184931",
            "fax_number": "530-752-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SHIELDS AVE",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956165270",
            "telephone_number": "530-752-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEISTIKOW",
        "first_name": "BRUCE",
        "middle_name": "NORMAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2013-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G80992",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "CA",
            "license": "G80992",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "CA",
            "license": "G80992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Russell Taylor Lee
• Wilson Lee, O.D.
• Toshio Raul Leeper, P.T.
• Mary-Helen B Leet, MA, MFT
• Eric B Lefever, MD
• Lauren Lemseffer, BCAT, RBT
• Lorena Leon Gutierrez
• John E. Leonard, PH.D.
• Linda Leong Lee, PHARM.D.
• Daria Leonov

• Occupational Medicine Physician in Davis, CA
• Providers in Davis, CA by specialty
• Occupational Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.