Provider Demographics
NPI:1538154877
Name:LEAF, DAVID N (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:LEAF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:SUITE 836
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:503-297-3653
Mailing Address - Fax:503-297-8173
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:SUITE 836
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-3653
Practice Address - Fax:503-297-8173
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR07915208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226993Medicaid
R0000BHGMSMedicare ID - Type UnspecifiedPROVIDER NUMBER
ORC93121Medicare UPIN