Provider Demographics
NPI:1972562841
Name:LEON, RICHARD SCOTT (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SCOTT
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-7301
Mailing Address - Country:US
Mailing Address - Phone:208-746-1383
Mailing Address - Fax:208-746-6348
Practice Address - Street 1:2315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7301
Practice Address - Country:US
Practice Address - Phone:208-746-1383
Practice Address - Fax:208-746-6348
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60249816207Q00000X
CAA75261207Q00000X
IDM-11434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1972562841OtherREGENCE BLUESHIELD
ID1972562841Medicaid
ID78909OtherBC/ID
WA31254OtherLABOR & INDUSTRIES
IDP01032049OtherRR MEDICARE
WA2015003Medicaid
WA31254OtherLABOR & INDUSTRIES
ID11965020Medicare PIN
IDP01032049OtherRR MEDICARE