Basic Information
| Provider Information | |||||||||
| NPI: | 1750647434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEEDLE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10151 SE SUNNYSIDE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036590880 | ||||||||
| FaxNumber: | 5035137425 | ||||||||
| Practice Location | |||||||||
| Address1: | 10151 SE SUNNYSIDE RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970155705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036590880 | ||||||||
| FaxNumber: | 5035137425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2012 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A127072 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD 60579852 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD178434 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.