Provider Demographics
NPI:1205941309
Name:VAN LEEUWEN, DIRK JACOB (MD, PHD, FAASLD)
Entity type:Individual
Prefix:DR
First Name:DIRK
Middle Name:JACOB
Last Name:VAN LEEUWEN
Suffix:
Gender:M
Credentials:MD, PHD, FAASLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SE MAIN ST STE 112
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2441
Mailing Address - Country:US
Mailing Address - Phone:503-255-3054
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2441
Practice Address - Country:US
Practice Address - Phone:503-255-3054
Practice Address - Fax:503-255-7651
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYEMERGENT207RG0100X
ORCP206793207RG0100X
NH11722207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100220249Medicaid
VT1009062Medicaid
NHRE6822Medicare ID - Type Unspecified
NH30202102Medicaid