Provider Demographics
NPI:1982942496
Name:LEONARD, DEANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:
Last Name:LEONARD
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 1:3615 NW SAMARITAN DR STE 203
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3771
Mailing Address - Country:US
Mailing Address - Phone:541-768-6930
Mailing Address - Fax:541-768-6931
Practice Address - Street 1:3615 NW SAMARITAN DR STE 203
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-768-6930
Practice Address - Fax:541-768-6931
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD183119207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500728666Medicaid