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General NPI Number Information
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NPI Number | 1609086834
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Entity Type | Organization
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Legal Business Name | LESLIE ORTHOPEDICS AND SPORTS MEDICINE INC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 226 E US HIGHWAY 54
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City | CAMDENTON
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State | MO
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Zip | 65020-6819
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Country | US
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Telephone | 573-346-3700
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Fax | 573-346-3307
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Provider Business Mailing Address
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Address Line | 226 E US HIGHWAY 54
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City | CAMDENTON
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State | MO
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Zip | 65020-6819
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Country | US
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Telephone | 573-346-3700
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Fax | 573-346-3307
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS ROBERT JOE BRUCE
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Credential | RN
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Telephone | 573-346-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | RP344
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License Number State | MO
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