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General NPI Number Information
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NPI Number | 1407928112
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Entity Type | Individual
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Provider Name | DANIEL ALLAN LEEDY MD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1508 DIVISION ST SUITE 115
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City | OREGON CITY
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State | OR
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Zip | 97045-1582
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Country | US
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Telephone | 503-656-0601
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Fax | 503-656-1389
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Provider Business Mailing Address
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Address Line | 541 NE 20TH AVE STE 225
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City | PORTLAND
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State | OR
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Zip | 97232-2895
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Country | US
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Telephone | 503-963-2801
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Fax | 503-963-2825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD17211
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD17211
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License Number State | OR
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