Healthcare Provider Details

I. General information

NPI: 1447859723
Provider Name (Legal Business Name): LESLIE M WALKER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 WEST SAMPLE ROADSUITE 301 & 103
FORT LAUDERDALE FL
33064-2510
US

IV. Provider business mailing address

1728 SW 4TH ST
FT LAUDERDALE FL
33312-7538
US

V. Phone/Fax

Practice location:
  • Phone: 954-486-4085
  • Fax:
Mailing address:
  • Phone: 954-695-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS22630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: