Provider Demographics
NPI:1215033436
Name:DENNIS-LEIGH, WILLIAM ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:DENNIS-LEIGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1050 401 BEL AIRE DR
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-1050
Mailing Address - Country:US
Mailing Address - Phone:503-728-5111
Mailing Address - Fax:503-728-5115
Practice Address - Street 1:401 SW BEL AIRE DR
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016-1050
Practice Address - Country:US
Practice Address - Phone:503-728-5111
Practice Address - Fax:503-728-5115
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA130052363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical