Provider Demographics
NPI:1447351424
Name:CHAPPELL, LELAND JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:LELAND
Middle Name:JEFFREY
Last Name:CHAPPELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:JEFFREY
Other - Last Name:CHAPPELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:BICKNELL
Mailing Address - State:UT
Mailing Address - Zip Code:84715-0303
Mailing Address - Country:US
Mailing Address - Phone:435-425-3744
Mailing Address - Fax:435-425-3785
Practice Address - Street 1:128 S. 300 W.
Practice Address - Street 2:
Practice Address - City:BICKNELL
Practice Address - State:UT
Practice Address - Zip Code:84715
Practice Address - Country:US
Practice Address - Phone:435-425-3744
Practice Address - Fax:435-425-3785
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184805-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10507Medicaid
UTF46912Medicare UPIN
UT461802Medicare ID - Type Unspecified