Healthcare Provider Details

I. General information

NPI: 1114916095
Provider Name (Legal Business Name): LEILA M AUGUST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 NE 66TH AVE
PORTLAND OR
97213-4557
US

IV. Provider business mailing address

3024 NE 66TH AVE
PORTLAND OR
97213-4557
US

V. Phone/Fax

Practice location:
  • Phone: 615-218-9576
  • Fax: 888-373-0083
Mailing address:
  • Phone: 615-218-9576
  • Fax: 888-373-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number189545
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: