MEDICARE: DR. JOHN T LESLIE 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
1	207Q00000X	Family Medicine Physician	E-5469	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5H064	OTHER	AR	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1760426746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN T LESLIE MD

Provider Business Mailing Address
First Line	:	675 HIGHWAY 62 E
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3207
Country	:	US
Telephone Number	:	870-508-7600
Fax Number	:	870-508-7609

Provider Business Practice Location Address
First Line	:	675 HIGHWAY 62 E
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72653-3207
Country	:	US
Telephone Number	:	870-508-7600
Fax Number	:	870-508-7609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	04/01/2019

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