Provider Demographics
NPI:1063848653
Name:EDDLEMAN, LESLIE ANN (DO)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:EDDLEMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:SPEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-0751
Mailing Address - Country:US
Mailing Address - Phone:918-772-3390
Mailing Address - Fax:918-772-2244
Practice Address - Street 1:1328 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-7650
Practice Address - Country:US
Practice Address - Phone:918-683-0470
Practice Address - Fax:918-683-0475
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5484207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine