Provider Demographics
NPI:1093995995
Name:LEDUC, LOUISE ELIZABETH (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:ELIZABETH
Last Name:LEDUC
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FORD RD
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-1088
Mailing Address - Country:US
Mailing Address - Phone:541-575-0404
Mailing Address - Fax:541-575-1124
Practice Address - Street 1:60458 MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:CANYON CITY
Practice Address - State:OR
Practice Address - Zip Code:97820-1206
Practice Address - Country:US
Practice Address - Phone:541-620-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
ORMD28160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR383998OtherMEDICARE - RURAL HEALTH CLINIC
ORR0000ZGBCVOtherMEDICARE - CLINIC/HOSPITAL GROUP NUMBER
OR213078Medicaid
OR213078Medicaid