Individual
LEAH MACKE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
401 RAILROAD ST W, MISSOULA, MT 59802-4109
(406) 258-4789
Mailing address
401 RAILROAD ST W, MISSOULA, MT 59802-4109
(406) 258-4789
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD50662894
WA
207R00000X
Internal Medicine Physician
MED-PHYS-LIC-102284
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679849640
—
WA
Enumeration date
03/23/2012
Last updated
11/02/2021
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