Provider Demographics
NPI:1043308208
Name:LESLIE, LARRY MILFORD (MD)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:MILFORD
Last Name:LESLIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:23 WILLOW DR
Practice Address - Street 2:
Practice Address - City:AUXIER
Practice Address - State:KY
Practice Address - Zip Code:41602-9259
Practice Address - Country:US
Practice Address - Phone:606-886-8997
Practice Address - Fax:606-886-1021
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY17881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64178817Medicaid
KYK028411Medicare PIN
KY64178817Medicaid