Healthcare Provider Details

I. General information

NPI: 1013911601
Provider Name (Legal Business Name): LUIS EDUARDO LEYTON-GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LUIS E LEYTON M.D.

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 08/10/2023
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEACEHEALTH HOSPITAL MEDICINE 3377 RIVERBEND DRIVE
SPRINGFIELD OR
97477-8803
US

IV. Provider business mailing address

PEACEHEALTH HOSPITAL MEDICINE 3377 RIVERBEND DRIVE
SPRINGFIELD OR
97477-8803
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6389
  • Fax: 541-222-6385
Mailing address:
  • Phone: 541-222-6389
  • Fax: 541-222-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD180254
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD180254
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: