Provider Demographics
NPI:1861429417
Name:LEONARD, DANN (MD)
Entity type:Individual
Prefix:DR
First Name:DANN
Middle Name:
Last Name:LEONARD
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 1:500 LIBERTY ST SE
Mailing Address - Street 2:STE 400
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3890
Mailing Address - Country:US
Mailing Address - Phone:503-391-2760
Mailing Address - Fax:503-391-0287
Practice Address - Street 1:500 LIBERTY ST SE
Practice Address - Street 2:STE 400
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3890
Practice Address - Country:US
Practice Address - Phone:503-391-2760
Practice Address - Fax:503-391-0287
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17833208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0262281OtherCIGNA HEALTH PLANS
OR240003876OtherRAILROAD MEDICARE
OR016416000OtherBLUE CROSS/BLUE SHIELD OR
OR046081Medicaid
OR5648306OtherAETNA HEALTH PLANS
OR046081Medicaid
OR240003876OtherRAILROAD MEDICARE