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NPI Code Detail

MEDICARE: LEONARD ALAN MANKIN MD

MEDICARE: LEONARD ALAN MANKIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD25913OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710992201
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONARD ALAN MANKIN MD
Provider Business Mailing Address
First Line : 1112 ERICKSON ST
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97034-4928
Country : US
Telephone Number : 503-938-9235
Fax Number :
Provider Business Practice Location Address
First Line : 1200 NW 23RD AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97210-2906
Country : US
Telephone Number : 503-494-8562
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 07/19/2007

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Directions to “ LEONARD ALAN MANKIN MD” Practice Location

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