Provider Demographics
NPI:1871577643
Name:LEFFEL, LINDA JOANN (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:JOANN
Last Name:LEFFEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 SW CHANDLER AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:541-388-3006
Mailing Address - Fax:541-382-7605
Practice Address - Street 1:1715 SW CHANDLER AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-388-3006
Practice Address - Fax:541-382-7605
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18444208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057096Medicaid
ORR140585Medicare PIN
OR057096Medicaid