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General NPI Number Information
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NPI Number | 1578517504
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Entity Type | Individual
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Provider Name | LESLIE L LISDELL MD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 112 NORTH 3RD STREET
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City | OKEMAH
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State | OK
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Zip | 74859-2602
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Country | US
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Telephone | 405-382-4939
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Fax | 405-382-4947
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Provider Business Mailing Address
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Address Line | 112 NORTH 3RD STREET
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City | OKEMAH
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State | OK
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Zip | 74859-2602
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Country | US
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Telephone | 918-623-3060
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Fax | 918-623-2380
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24484
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-5170
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J8643
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License Number State | TX
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