Provider Demographics
NPI:1326279464
Name:RAPHAEL, LESLEY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANNE
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:ANNE
Other - Last Name:WOJCIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:505 NE 87TH AVE
Mailing Address - Street 2:SUITE 46.5
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1989
Mailing Address - Country:US
Mailing Address - Phone:360-828-5396
Mailing Address - Fax:360-828-5455
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-828-5396
Practice Address - Fax:360-828-5455
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP24247207R00000X
WAMD60339342207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine