Healthcare Provider Details

I. General information

NPI: 1265405534
Provider Name (Legal Business Name): LESLIE JAMES ALLISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 INDIANAPOLIS BLVD
HAMMOND IN
46324-2206
US

IV. Provider business mailing address

5080 SPECTRUM DR STE 1200W
ADDISON TX
75001-4624
US

V. Phone/Fax

Practice location:
  • Phone: 219-763-8112
  • Fax: 219-764-3251
Mailing address:
  • Phone: 972-720-7820
  • Fax: 214-775-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ7408
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: