Provider Demographics
NPI:1730327966
Name:JONES, LEAH (MD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:BERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4514 E HORSEHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4656
Mailing Address - Country:US
Mailing Address - Phone:520-544-9890
Mailing Address - Fax:
Practice Address - Street 1:2290 W PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8424
Practice Address - Country:US
Practice Address - Phone:208-772-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37717207Q00000X
CAG88179207Q00000X
HI17667207QH0002X
AZ43404207QH0002X
IDM-12862207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN35721290OtherMEDICAL ASSISTANCE
MNF95817Medicare UPIN
MN080005058Medicare PIN