Provider Demographics
NPI:1225119126
Name:MURCHISON, LESLEY C (MD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:C
Last Name:MURCHISON
Suffix:
Gender:F
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 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1300 W LANCASTER AVE
Practice Address - Street 2:STE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3410
Practice Address - Country:US
Practice Address - Phone:817-870-2910
Practice Address - Fax:817-870-2180
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750369203OtherGRP NPI NUMBER
TX1392580OtherUHC PIN
TX4140237OtherAETNA PIN
TX87043GOtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
TX127166008Medicaid
TX137345801Medicaid
TX177056201Medicaid
TX120049100OtherFIRSTCARE PIN
TX127166007Medicaid
TX4340938OtherCIGNA PIN
TXMURLB25033OtherCCHIP PIN
TX46864OtherFIRSTHEALTH PIN
TX46864OtherFIRSTHEALTH PIN
TX00740ZMedicare PIN
TX177056201Medicaid
TX8069N5Medicare PIN
TX00480RMedicare PIN