Healthcare Provider Details

I. General information

NPI: 1063422608
Provider Name (Legal Business Name): ALEXANDER LEIGHTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 5TH STREET SUITE 2
BROOKINGS OR
97415
US

IV. Provider business mailing address

555 5TH STREET SUITE 2
BROOKINGS OR
97415
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-9205
  • Fax: 541-469-9204
Mailing address:
  • Phone: 541-469-9205
  • Fax: 541-469-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD23295
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA85511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: