Healthcare Provider Details

I. General information

NPI: 1124024476
Provider Name (Legal Business Name): LESLIE S NEWTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17191 BOTHELL WAY NE STE 205
LAKE FOREST PARK WA
98155-5534
US

IV. Provider business mailing address

17191 BOTHELL WAY NE STE 205
LAKE FOREST PARK WA
98155-5534
US

V. Phone/Fax

Practice location:
  • Phone: 206-364-8272
  • Fax:
Mailing address:
  • Phone: 206-364-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00013244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: