Provider Demographics
NPI:1134113905
Name:BROCKWAY, LEAH W (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:W
Last Name:BROCKWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1614 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1053
Mailing Address - Country:US
Mailing Address - Phone:509-995-3307
Mailing Address - Fax:509-747-4234
Practice Address - Street 1:92 MEDICAL GROUP/ FLIGHT MEDICINE CLINIC
Practice Address - Street 2:700 HOSPITAL LOOP, BLDG 9000
Practice Address - City:FAIRCHILD AFB
Practice Address - State:WA
Practice Address - Zip Code:99011
Practice Address - Country:US
Practice Address - Phone:509-247-5755
Practice Address - Fax:509-247-8833
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5279439-1205207Q00000X
WAMD000411032083A0100X
AL11633208600000X
LA17373208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery