Provider Demographics
NPI:1295829331
Name:THOMAS, LESLIE D (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:THOMAS
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 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-415-3420
Mailing Address - Fax:816-781-3517
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 310
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-415-3420
Practice Address - Fax:816-781-3517
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5H42174400000X, 207X00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
C51922Medicare UPIN