=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265405534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE JAMES ALLISON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2006
-----------------------------------------------------
Last Update Date | 03/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6920 INDIANAPOLIS BLVD
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46324-2206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-763-8112
-----------------------------------------------------
Fax | 219-764-3251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5080 SPECTRUM DR STE 1200W
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-720-7820
-----------------------------------------------------
Fax | 214-775-4502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | J7408
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------