Provider Demographics
NPI:1407848831
Name:MCALLISTER, LESLIE DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DAVIS
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:975 SE SANDY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1308
Mailing Address - Country:US
Mailing Address - Phone:503-963-2846
Mailing Address - Fax:503-963-9505
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-488-2424
Practice Address - Fax:503-229-1705
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD204362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134160Medicaid
WA8245540Medicaid
ORF23420Medicare UPIN
WA8245540Medicaid