Healthcare Provider Details

I. General information

NPI: 1720012628
Provider Name (Legal Business Name): LESLIE M HAMLETT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W BROADWAY
COLUMBIA MO
65203-2125
US

IV. Provider business mailing address

1205 W BROADWAY
COLUMBIA MO
65203-2125
US

V. Phone/Fax

Practice location:
  • Phone: 573-499-0642
  • Fax: 573-449-1787
Mailing address:
  • Phone: 573-499-0642
  • Fax: 573-449-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2002010256
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: