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NPI Code Detail

MEDICARE: LESLIE W SMITH DO

MEDICARE:   LESLIE W SMITH  DO
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
12086S0122XPlastic and Reconstructive Surgery Physician101951MN
22086S0122XPlastic and Reconstructive Surgery Physician4390IA

General Provider Information

NPI Number : 1245274745
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE W SMITH DO
Provider Business Mailing Address
First Line : 621 S ILLINOIS AVE
Second Line : SUITE 103
City : MASON CITY
State : IA
Zip : 50401-5489
Country : US
Telephone Number : 641-428-3041
Fax Number : 641-428-3059
Provider Business Practice Location Address
First Line : 1501 4TH ST SW
Second Line :
City : MASON CITY
State : IA
Zip : 50401-2737
Country : US
Telephone Number : 641-428-5932
Fax Number : 641-428-6160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 04/18/2013

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Directions to “ LESLIE W SMITH DO” Practice Location

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