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General NPI Number Information
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NPI Number | 1477608099
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Entity Type | Individual
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Provider Name | DARIN LESLIE PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2375 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone | 208-522-4600
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Fax | 208-552-7521
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Provider Business Mailing Address
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Address Line | 689 E 700 N
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City | FIRTH
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State | ID
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Zip | 83236-1117
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Country | US
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Telephone | 208-346-6718
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Fax | 208-552-7521
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-514
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License Number State | ID
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