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General NPI Number Information
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NPI Number | 1710902440
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Entity Type | Individual
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Provider Name | LESLIE R MCGOWAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 6027 WALNUT GROVE SUITE 319 THE UROLOGY GROUP PC
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City | MEMPHIS
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State | TN
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Zip | 38120-2128
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Country | US
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Telephone | 901-767-8158
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Fax | 901-767-1555
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Provider Business Mailing Address
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Address Line | 6027 WALNUT GROVE SUITE 319 THE UROLOGY GROUP PC
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City | MEMPHIS
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State | TN
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Zip | 38120-2128
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Country | US
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Telephone | 901-767-8158
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Fax | 901-767-1555
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD0000014127
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License Number State | TN
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