=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821119280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LESLIE LUNG CONSULTANTS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 03/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7801 LAKEVIEW PKWY SUITE 130
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-4247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-412-6969
-----------------------------------------------------
Fax | 972-412-6639
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7801 LAKEVIEW PKWY SUITE 130
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-4247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-412-6969
-----------------------------------------------------
Fax | 972-412-6639
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | WILLIAM K. LESLIE
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 972-412-6969
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | F6875
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------