Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | E-1651 | AR |
NPI | 1003873019 |
---|---|
Provider Name | Leslie Mccasland |
First Address | Jonesboro, AR 72401 |
Second Address | Jonesboro, AR 72401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 18/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134967001 | (05) | AR |
G74527 | (02) | AR |