Provider Demographics
NPI:1730148958
Name:LEINWEBER, ELDON LESTER (PA-C)
Entity type:Individual
Prefix:
First Name:ELDON
Middle Name:LESTER
Last Name:LEINWEBER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:
Mailing Address - City:SOAP LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98851-1050
Mailing Address - Country:US
Mailing Address - Phone:509-888-9606
Mailing Address - Fax:509-683-1135
Practice Address - Street 1:22 WEST HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:SOAP LAKE
Practice Address - State:WA
Practice Address - Zip Code:98851
Practice Address - Country:US
Practice Address - Phone:509-888-9606
Practice Address - Fax:509-683-1135
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8418451Medicaid
WA211648OtherLABOR & INDUSTRIES ID #
WA6612LEOtherREGENCE PROVIDER #
WA0193143OtherLABOR &INDUSTRIES ID #
WA1051425OtherNCCPA CERTIFICATION
WA1051425OtherNCCPA CERTIFICATION
WA1051425OtherNCCPA CERTIFICATION