Healthcare Provider Details

I. General information

NPI: 1760774798
Provider Name (Legal Business Name): LESLIE ANN COLIP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 87TH AVE STE 280
VANCOUVER WA
98664-4896
US

IV. Provider business mailing address

700 NE 87TH AVE STE 280
VANCOUVER WA
98664-4896
US

V. Phone/Fax

Practice location:
  • Phone: 503-261-6912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD463319
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD202937
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD.MD.61677426
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: