Provider Demographics
NPI:1407113756
Name:OGLESBY, LESLIE H (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:H
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:DIANE
Other - Last Name:HIGHFILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4864 JACKSON ST
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-6400
Mailing Address - Country:US
Mailing Address - Phone:318-675-7650
Mailing Address - Fax:318-675-7613
Practice Address - Street 1:4864 JACKSON ST
Practice Address - Street 2:FAMILY MEDICINE
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-6400
Practice Address - Country:US
Practice Address - Phone:318-675-7650
Practice Address - Fax:318-675-7613
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.208176207P00000X, 207Q00000X
LAMD208176207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty