Provider Demographics
NPI:1134142649
Name:MALKIN, LEON H (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:H
Last Name:MALKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 NW SAMARITAN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4714
Mailing Address - Country:US
Mailing Address - Phone:541-768-6300
Mailing Address - Fax:541-768-6301
Practice Address - Street 1:3620 NW SAMARITAN DR
Practice Address - Street 2:STE 201
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4714
Practice Address - Country:US
Practice Address - Phone:541-768-6300
Practice Address - Fax:541-768-6301
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15938207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR025106Medicaid
130058Medicare ID - Type Unspecified
OR025106Medicaid