Provider Demographics
NPI:1255325882
Name:POOL, LESLIE GLENN (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:GLENN
Last Name:POOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-343-7501
Mailing Address - Fax:208-336-8248
Practice Address - Street 1:100 E IDAHO ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6267
Practice Address - Country:US
Practice Address - Phone:208-343-7501
Practice Address - Fax:208-336-8248
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM3887207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology