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General NPI Number Information
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NPI Number | 1104842483
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Entity Type | Individual
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Provider Name | LESLIE GRACE LANDRUM M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 1100 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1944
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Country | US
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Telephone | 479-443-4301
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Fax |
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Provider Business Mailing Address
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Address Line | 3232 N NORTHHILLS BLVD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4005
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Country | US
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Telephone | 479-750-7799
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Fax | 479-751-5744
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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 | C7717
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | C7717
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License Number State | AR
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