Provider Demographics
NPI:1134213218
Name:GREENLEAF, DELMAR LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:DELMAR
Middle Name:LEWIS
Last Name:GREENLEAF
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 1:804 NE THIRD ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-317-5533
Mailing Address - Fax:541-617-2919
Practice Address - Street 1:804 NE THIRD ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-317-5533
Practice Address - Fax:541-617-2919
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061705Medicaid
ORR106352Medicare PIN