Healthcare Provider Details

I. General information

NPI: 1285614206
Provider Name (Legal Business Name): DONALD TICE LESHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WEST 2ND ST
RUTHERFORDTON NC
28139-0886
US

IV. Provider business mailing address

PO BOX 886 447 NORTH WASHINGTON ST
RUTHERFORDTON NC
28139-0886
US

V. Phone/Fax

Practice location:
  • Phone: 828-287-2984
  • Fax: 828-287-3582
Mailing address:
  • Phone: 828-287-3194
  • Fax: 828-287-3582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number24170
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: