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1497713200

NPI Code Detail

MEDICARE: RICHARD LESLIE SAMPLE MD

MEDICARE: RICHARD LESLIE SAMPLE MD

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	DO898	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	051557580	OTHER	AL	MEDICARE PROVIDER #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0403254	OTHER	AL	UNITED HEALTHCARE
3	630813275	OTHER	AL	COMMERCIAL
5	051542076	OTHER	AL	BCBS PROVIDER #

General Provider Information

NPI Number	:	1497713200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LESLIE SAMPLE MD

Provider Business Mailing Address
First Line	:	4371 NARROW LANE RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2975
Country	:	US
Telephone Number	:	334-613-3680
Fax Number	:	334-613-3685

Provider Business Practice Location Address
First Line	:	4371 NARROW LANE RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2971
Country	:	US
Telephone Number	:	334-613-3680
Fax Number	:	334-613-3685

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	03/27/2008

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Directions to “ RICHARD LESLIE SAMPLE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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