Basic Information
| Provider Information | |||||||||
| NPI: | 1215033436 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENNIS-LEIGH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1050 401 BEL AIRE DR | ||||||||
| Address2: | |||||||||
| City: | CLATSKANIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970161050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037285111 | ||||||||
| FaxNumber: | 5037285115 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 SW BEL AIRE DR | ||||||||
| Address2: | |||||||||
| City: | CLATSKANIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970161050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037285111 | ||||||||
| FaxNumber: | 5037285115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 08/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA130052 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.