Basic Information
| Provider Information | |||||||||
| NPI: | 1205941309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAN LEEUWEN | ||||||||
| FirstName: | DIRK | ||||||||
| MiddleName: | JACOB | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PH.D., FAASLD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10000 SE MAIN ST STE 112 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032553054 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10000 SE MAIN ST STE 112 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032553054 | ||||||||
| FaxNumber: | 5032557651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 09/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | EMERGENT | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | CP206793 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.