Provider Demographics
NPI:1831212976
Name:LEONARD, DOUGLAS TERRY (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:TERRY
Last Name:LEONARD
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 1:3355 RIVER BEND DR.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8800
Mailing Address - Country:US
Mailing Address - Phone:541-688-8790
Mailing Address - Fax:541-687-4940
Practice Address - Street 1:3355 RIVER BEND DR.
Practice Address - Street 2:SUITE 220
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-688-8790
Practice Address - Fax:541-687-4940
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD275082080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241579Medicaid