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NPI Code Detail

MEDICARE: AMBER MARIE LESLEY MD

MEDICARE: AMBER MARIE LESLEY MD
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
1207R00000XInternal Medicine PhysicianM8791TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00643341OTHERTXRAIL ROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1679782908
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER MARIE LESLEY MD
Provider Business Mailing Address
First Line : PO BOX 961205
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-1205
Country : US
Telephone Number : 817-740-8400
Fax Number : 817-921-5446
Provider Business Practice Location Address
First Line : 5612 EDWARDS RANCH RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4145
Country : US
Telephone Number : 817-921-5446
Fax Number : 817-377-6560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 12/18/2020

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Directions to “ AMBER MARIE LESLEY MD” Practice Location

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