Healthcare Provider Details

I. General information

NPI: 1134142649
Provider Name (Legal Business Name): LEON H MALKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 NW SAMARITAN DR STE 201
CORVALLIS OR
97330-4714
US

IV. Provider business mailing address

3620 NW SAMARITAN DR SUITE 201
CORVALLIS OR
97330-4714
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-6300
  • Fax: 541-768-6301
Mailing address:
  • Phone: 541-768-6300
  • Fax: 541-768-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD15938
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: