Provider Demographics
NPI:1093839003
Name:LEYNGOLD, MARK MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MICHAEL
Last Name:LEYNGOLD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3015 E GOLDSTONE DR # 130
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1549
Mailing Address - Country:US
Mailing Address - Phone:208-900-4673
Mailing Address - Fax:208-266-5033
Practice Address - Street 1:3015 E GOLDSTONE DR # 130
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1549
Practice Address - Country:US
Practice Address - Phone:208-900-4673
Practice Address - Fax:208-266-5033
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME116419208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008971400Medicaid
ID20024303OtherMEDICARE