Provider Demographics
NPI:1265639637
Name:EASLEY, LESLIE (DO)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:EASLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:EASLEY
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:5021 N 20TH ST
Mailing Address - Street 2:SUITE 10630
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4166
Mailing Address - Country:US
Mailing Address - Phone:480-209-9173
Mailing Address - Fax:
Practice Address - Street 1:13677 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8539
Practice Address - Country:US
Practice Address - Phone:623-882-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1040207R00000X
AZ005525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine