Healthcare Provider Details

I. General information

NPI: 1326045865
Provider Name (Legal Business Name): W HUGH LEEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 SUPERIOR ST
SANDPOINT ID
83864-1735
US

IV. Provider business mailing address

6635 COMANCHE ST PO BOX Q
BONNERS FERRY ID
83805-7523
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-1718
  • Fax: 208-263-7198
Mailing address:
  • Phone: 208-267-1718
  • Fax: 208-267-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3333
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: