MEDICARE: DR. LESLIE ANNE WILLINGHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	44577	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z146300	OTHER	AZ	MEDICARE PTAN

General Provider Information

NPI Number	:	1174787790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ANNE WILLINGHAM M.D.

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD
Second Line	:	A100
City	:	TUCSON
State	:	AZ
Zip	:	85711-3640
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	5555 E 5TH ST STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2415
Country	:	US
Telephone Number	:	520-886-4181
Fax Number	:	520-721-7536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2008
Last Update Date	:	10/02/2017

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