Provider Demographics
NPI:1194731703
Name:LEIGHTON, JULIANE (MD)
Entity type:Individual
Prefix:
First Name:JULIANE
Middle Name:
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 5TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-9702
Mailing Address - Country:US
Mailing Address - Phone:541-469-9205
Mailing Address - Fax:541-469-9204
Practice Address - Street 1:555 5TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9702
Practice Address - Country:US
Practice Address - Phone:541-469-9205
Practice Address - Fax:541-469-9204
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMDZ3296207R00000X
CAA85512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00224676OtherRAILROAD
OR262305Medicaid
R118290Medicare ID - Type Unspecified
OR262305Medicaid