Jerry Wayne Leonard Sr., D.MD.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

OR5193 Issued in OR

Practice address

2614 NE 22ND Ave
Portland, OR 97212-4816

Phone

(503) 284-8114

NPI assigned

Aug 19, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1578678983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2614 NE 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972124816",
            "telephone_number": "503-284-8114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2614 NE 22ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972124816",
            "telephone_number": "503-284-8114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONARD",
        "first_name": "JERRY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.MD.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "OR5193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hanna Leonard, RN, NNP
• Hubert A Leonard, MD
• Hugh Leonard, CRM
• Jacob Leonard
• Jennifer S Leonard, LMT
• Jessica N Leonard, EPRDH
• Jessica Taft Leonard, M.D.
• Jerry Wayne Leonard, Jr., D.M.D.
• Katherine Marie Leonard, PHD
• Leah Diane Leonard, DDS

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.