Individual
MR. LELAND MATTHEW PICCOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
9155 SW BARNES RD, SUITE 440, PORTLAND, OR 97225-6625
(503) 297-3766
(503) 297-8148
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01395
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114116993
—
WA
05
—
500604187
—
OR
Enumeration date
10/17/2007
Last updated
03/07/2022
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