MEDICARE: LESLIE JOHN DERDEYN 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	2085R0202X	Diagnostic Radiology Physician	F3900	TX

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

General Provider Information

NPI Number	:	1831198209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE JOHN DERDEYN MD

Provider Business Mailing Address
First Line	:	13737 NOEL RD STE 1600
Second Line	:	ATTN RAYS
City	:	DALLAS
State	:	TX
Zip	:	75240-1374
Country	:	US
Telephone Number	:	303-933-8270
Fax Number	:	303-933-8270

Provider Business Practice Location Address
First Line	:	13737 NOEL RD STE 1600
Second Line	:	ATTN RAYS
City	:	DALLAS
State	:	TX
Zip	:	75240-1374
Country	:	US
Telephone Number	:	303-933-8270
Fax Number	:	303-933-8270

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	05/31/2013

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