Healthcare Provider Details

I. General information

NPI: 1548270903
Provider Name (Legal Business Name): LESLIE MILTON O'STEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 POCAHONTAS DR
FT WALTON BCH FL
32547-3220
US

IV. Provider business mailing address

563 POCAHONTAS DR
FT WALTON BCH FL
32547-3220
US

V. Phone/Fax

Practice location:
  • Phone: 850-862-1200
  • Fax:
Mailing address:
  • Phone: 850-862-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME 20878
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: