Organization
LESLIE CANYON FAMILY MEDICINE, P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUCIEN T MEGNA MD (PRESIDIENT / CEO)
(509) 628-2331
Entity
Organization
Contact information
Practice address
705 GAGE BLVD, SUITE 200, RICHLAND, WA 99352-9701
(509) 628-2331
(509) 628-0537
Mailing address
705 GAGE BLVD, SUITE 200, RICHLAND, WA 99352-9701
(509) 628-2331
(509) 628-0537
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
WA00034155
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11151316
CAQH
—
05
—
7077993
—
WA
Enumeration date
11/13/2007
Last updated
06/21/2018
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