Morgan Leder
Individual provider Active NPI Contractor · Canby, OR
NPI 1720529100 · NPPES record last updated Oct 19, 2022
Key facts
- NPI
- 1720529100
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 171W00000X (WA)
- Practice address
- 26150 S Gelbrich Rd
Canby, OR 97013-9153 - Phone
- (503) 951-3175
- NPI assigned
- Mar 17, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 171W00000X | WA | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prime Perfusion Inc | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 171W00000X | WA | Yes |
Addresses
Primary practice location
26150 S Gelbrich Rd
Canby, OR 97013-9153
Mailing address
26150 S Gelbrich Rd
Canby, OR 97013-9153
Phone (503) 951-3175
Other practice location 1
12356 Monitor McKee Rd NE
Woodburn, OR 97071-9089
Phone (503) 951-3175
Other providers in Canby, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.