Healthcare Provider Details

I. General information

NPI: 1669419990
Provider Name (Legal Business Name): LARRY MILFORD LESLIE II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 9TH ST N STE 300
NAPLES FL
34102-5820
US

IV. Provider business mailing address

399 9TH ST N STE 300
NAPLES FL
34102-5820
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-4200
  • Fax: 239-624-4201
Mailing address:
  • Phone: 239-624-4200
  • Fax: 239-624-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01062082A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34948
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number34948
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01062082A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME125405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: