Healthcare Provider Details

I. General information

NPI: 1689632457
Provider Name (Legal Business Name): LESLIE DIANE GREGORY P.A.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 NE 6TH AVE
ESTACADA OR
97023-9312
US

IV. Provider business mailing address

8630 SE KING RD
HAPPY VALLEY OR
97086-7402
US

V. Phone/Fax

Practice location:
  • Phone: 503-630-8550
  • Fax: 503-630-8551
Mailing address:
  • Phone: 503-913-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00823
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: