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NPI Code Detail

MEDICARE: LESLIE J DAVIS D.O.

MEDICARE: LESLIE J DAVIS D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician2020020189MO

General Provider Information

NPI Number : 1083145601
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE J DAVIS D.O.
Provider Business Mailing Address
First Line : 1465 S GRAND BLVD RM 2717
Second Line : SSM HEALTH CARDINAL GLENNON CHILDREN'S HOSPITAL
City : SAINT LOUIS
State : MO
Zip : 63104-1003
Country : US
Telephone Number : 314-577-5634
Fax Number : 314-577-5616
Provider Business Practice Location Address
First Line : 1465 S GRAND BLVD RM 2717
Second Line : 1465 SOUTH GRAND BLVD, RM 2717
City : SAINT LOUIS
State : MO
Zip : 63104-1003
Country : US
Telephone Number : 314-577-5634
Fax Number : 314-577-5616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2017
Last Update Date : 03/11/2021

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