Healthcare Provider Details

I. General information

NPI: 1407113756
Provider Name (Legal Business Name): LESLIE H OGLESBY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESLIE DIANE HIGHFILL MD

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST FAMILY MEDICINE
MONROE LA
71202-6400
US

IV. Provider business mailing address

4864 JACKSON ST FAMILY MEDICINE
MONROE LA
71202-6400
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-7650
  • Fax: 318-675-7613
Mailing address:
  • Phone: 318-675-7650
  • Fax: 318-675-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.208176
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD208176
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.208176
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: