Provider Demographics
NPI:1003995473
Name:BOGRAN, LESLIE ANN
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:BOGRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1209
Mailing Address - Country:US
Mailing Address - Phone:985-892-4563
Mailing Address - Fax:
Practice Address - Street 1:1125 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1209
Practice Address - Country:US
Practice Address - Phone:985-892-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1340057Medicaid