Healthcare Provider Details

I. General information

NPI: 1790106417
Provider Name (Legal Business Name): LESLIE SMITH HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LESLIE DAME

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 SAINT ANDREWS BLVD
PANAMA CITY FL
32405-2158
US

IV. Provider business mailing address

2232 SAINT ANDREWS BLVD
PANAMA CITY FL
32405-2158
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-4327
  • Fax: 850-784-0060
Mailing address:
  • Phone: 850-784-4327
  • Fax: 850-784-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS4945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: