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NPI Code Detail

MEDICARE: DR. LESLIE H SECREST M.D.

MEDICARE: DR. LESLIE H SECREST M.D.
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
12084P0800XPsychiatry PhysicianD5202TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100R654OTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417987637
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LESLIE H SECREST M.D.
Provider Business Mailing Address
First Line : PO BOX 195783
Second Line :
City : DALLAS
State : TX
Zip : 75219-8613
Country : US
Telephone Number : 214-225-0848
Fax Number : 214-345-8753
Provider Business Practice Location Address
First Line : 8222 DOUGLAS AVE STE 604
Second Line :
City : DALLAS
State : TX
Zip : 75225-5937
Country : US
Telephone Number : 214-225-0848
Fax Number : 469-250-4802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 12/22/2021

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