Provider Demographics
NPI:1144206327
Name:DOS REIS, LESLIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:DOS REIS
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 1:960 N 16TH ST
Mailing Address - Street 2:SUITE105
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4175
Mailing Address - Country:US
Mailing Address - Phone:541-726-4699
Mailing Address - Fax:541-744-6069
Practice Address - Street 1:960 N 16TH ST
Practice Address - Street 2:SUITE105
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4175
Practice Address - Country:US
Practice Address - Phone:541-726-4699
Practice Address - Fax:541-744-6069
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD085832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241281Medicaid
OR00WCGGVAMedicare PIN
ORE35470Medicare UPIN