Provider Demographics
NPI:1376610048
Name:NOWIERSKI, LEON WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:WILLIAM
Last Name:NOWIERSKI
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 1:100 WARM SPRINGS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6243
Mailing Address - Country:US
Mailing Address - Phone:208-343-5910
Mailing Address - Fax:208-384-8562
Practice Address - Street 1:100 WARM SPRINGS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6243
Practice Address - Country:US
Practice Address - Phone:208-343-5910
Practice Address - Fax:208-384-8562
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4341207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID43414OtherBLUE CROSS OF IDAHO
ID000010021230OtherBLUE SHIELD OF IDAHO
ID002586300Medicaid
ID43414OtherBLUE CROSS OF IDAHO
IDC47843Medicare UPIN