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General NPI Number Information
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NPI Number | 1063848653
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Entity Type | Individual
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Provider Name | LESLIE ANN EDDLEMAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 1328 S YORK ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-7650
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Country | US
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Telephone | 918-683-0470
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Fax | 918-683-0475
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Provider Business Mailing Address
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Address Line | PO BOX 751
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City | HULBERT
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State | OK
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Zip | 74441-0751
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Country | US
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Telephone | 918-772-3390
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Fax | 918-772-2244
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5484
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5484
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License Number State | OK
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