Healthcare Provider Details

I. General information

NPI: 1538187125
Provider Name (Legal Business Name): GORDON D LEINGANG D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 9TH ST
BISMARCK ND
58501-4530
US

IV. Provider business mailing address

401 N 9TH ST
BISMARCK ND
58501-4530
US

V. Phone/Fax

Practice location:
  • Phone: 701-712-4500
  • Fax:
Mailing address:
  • Phone: 701-712-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number6895
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier13166
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBCBSND
# 2
Identifier1454482
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 3
Identifier930028709
Identifier TypeOTHER
Identifier StateND
Identifier IssuerRR MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: