Healthcare Provider Details

I. General information

NPI: 1528017282
Provider Name (Legal Business Name): LESLIE HART BEAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 HOSPITAL DR # 462
JACKSON MS
39204
US

IV. Provider business mailing address

1815 HOSPITAL DR # 462
JACKSON MS
39204
US

V. Phone/Fax

Practice location:
  • Phone: 601-373-0594
  • Fax: 601-372-9443
Mailing address:
  • Phone: 601-373-0594
  • Fax: 601-372-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number06156
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: