Jerry Wayne Leonard, Jr., D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

D7672 Issued in OR

Practice address

5329 NE M L King Blvd
Portland, OR 97211-3237

Phone

(503) 988-3664

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: jleonard4645@direct.ochin.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1548338684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25796 SW CANYON CREEK RD",
            "address_2": "APT D304",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709659",
            "telephone_number": "503-682-5612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5329 NE M L KING BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972113237",
            "telephone_number": "503-988-3664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONARD, JR.",
        "first_name": "JERRY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Leonard
• Jennifer S Leonard, LMT
• Jerry Wayne Leonard Sr., D.MD.
• Jessica N Leonard, EPRDH
• Jessica Taft Leonard, M.D.
• Katherine Marie Leonard, PHD
• Leah Diane Leonard, DDS
• Marc David Leonard
• Kathryn Kanani Leonardi
• Nikki Christine Leonardi, LMT

• Dentist in Portland, OR
• Providers in Portland, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.