Provider Demographics
NPI:1568427086
Name:LIAN-LEAF, EUNICE R (MD)
Entity Type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:R
Last Name:LIAN-LEAF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36091 SE COLORADO RD
Mailing Address - Street 2:C/O UNLISTED - PLEASE DO NOT PUBLISH
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36091 SE COLORADO RD
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8277
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR229306Medicaid
OR110137Medicare ID - Type Unspecified
H44996Medicare UPIN