Provider Demographics
NPI:1164453486
Name:WALTERS, LESLIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:L
Last Name:WALTERS
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 496148
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-6148
Mailing Address - Country:US
Mailing Address - Phone:972-739-7445
Mailing Address - Fax:214-692-7478
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-739-7445
Practice Address - Fax:214-692-7478
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3536207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117434403Medicaid
TX89127ZOtherBLUE CROSS
TX117434403Medicaid
TX89127ZOtherBLUE CROSS