Provider Demographics
NPI:1336139807
Name:SANDKNOP, LES T (DO)
Entity Type:Individual
Prefix:
First Name:LES
Middle Name:T
Last Name:SANDKNOP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 W RALPH HALL PKWY STE 221
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6662
Mailing Address - Country:US
Mailing Address - Phone:972-771-9000
Mailing Address - Fax:972-771-9002
Practice Address - Street 1:1005 W RALPH HALL PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6658
Practice Address - Country:US
Practice Address - Phone:972-771-9081
Practice Address - Fax:972-772-7102
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD79647Medicare UPIN
TX8348J0Medicare ID - Type UnspecifiedMEDICARE PROVIDER #