Healthcare Provider Details

I. General information

NPI: 1821050022
Provider Name (Legal Business Name): LESLIE F ANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 SE FRONT STREET
LONOKE AR
72086-3025
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-266-7265
  • Fax: 501-266-7269
Mailing address:
  • Phone: 501-266-7265
  • Fax: 501-266-7269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC-4445
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: