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General NPI Number Information
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NPI Number | 1437133352
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Entity Type | Individual
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Provider Name | LESLIE C LOCKRIDGE MD
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Gender | Male
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 639 HOSPITAL DR
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-2914
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Country | US
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Telephone | 479-587-1700
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Fax | 479-587-1366
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Provider Business Mailing Address
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Address Line | 3901 PARKWAY CIR
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City | SPRINGDALE
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State | AR
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Zip | 72762-6362
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Country | US
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Telephone | 479-587-1700
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Fax | 479-587-1366
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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 | MD10934
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD10934
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 0420011226
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License Number State | VT
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 217751
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 042-0011226
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License Number State | VT
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Taxonomy #6
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | E18889
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License Number State | AR
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