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NPI Code Detail

MEDICARE: DR. NATHAN EDWIN LESLEY MD

MEDICARE: DR. NATHAN EDWIN 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
1207X00000XOrthopaedic Surgery PhysicianN0921TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01021883OTHERTXRAILROAD 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 : 1982836433
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHAN EDWIN 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 : 817-877-3277
Fax Number : 817-877-3280
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 : 817-420-9238
Fax Number : 817-357-4363
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2009
Last Update Date : 12/18/2020

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