Provider Demographics
NPI:1619920733
Name:LEIER, DARRELL JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:JOHN
Last Name:LEIER
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 1:319 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:HOYT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55750-1103
Mailing Address - Country:US
Mailing Address - Phone:218-225-2063
Mailing Address - Fax:
Practice Address - Street 1:319 VIKING DR
Practice Address - Street 2:
Practice Address - City:HOYT LAKES
Practice Address - State:MN
Practice Address - Zip Code:55750-1103
Practice Address - Country:US
Practice Address - Phone:218-225-2063
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D48753Medicare UPIN