Provider Demographics
NPI:1588848311
Name:JUDAH, LESLIE DWAIN (PA-C)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DWAIN
Last Name:JUDAH
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 1:610 S SHERMAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1342
Mailing Address - Country:US
Mailing Address - Phone:509-458-7720
Mailing Address - Fax:509-777-0432
Practice Address - Street 1:610 S SHERMAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1342
Practice Address - Country:US
Practice Address - Phone:509-458-7720
Practice Address - Fax:509-777-0432
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant