Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 310277 | LA |
NPI | 1033536529 |
---|---|
Provider Name | David Leslie |
First Address | New Orleans, LA 70121-2429 |
Second Address | Jefferson, LA 70121-1015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 28/09/2018 |