Provider Demographics
NPI:1093888091
Name:LESH, PHILLIP C (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:C
Last Name:LESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000237702085N0904X
WAMD000237702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8944811OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA8945535OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WAAB36527OtherMEDICARE PIN TRA KING COUNTY
WALE4084OtherREGENCE BLUE SHIELD TRA
WA119259OtherLABOR AND INDUSTRIES/WC UNION AVENUE OPEN
WA40721OtherLABOR AND INDUSTRIES/WC TRA
WA300023013OtherRR MEDICARE TRA
WAG8892476OtherPTAN-DOCTORS CLINIC
WALE7252OtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WA0249526OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA8125379Medicaid
WA8951850OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WAG8881780OtherPTAN-MIO1
WA8951850OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WALE7252OtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WAG8892476OtherPTAN-DOCTORS CLINIC