Provider Demographics
NPI:1437563533
Name:WILLIAMS, LESLIE DELVIN (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DELVIN
Last Name:WILLIAMS
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 1:1688 W GRANADA BLVD STE 2A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1818
Mailing Address - Country:US
Mailing Address - Phone:386-425-4460
Mailing Address - Fax:386-425-4461
Practice Address - Street 1:1688 W GRANADA BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1818
Practice Address - Country:US
Practice Address - Phone:386-425-4460
Practice Address - Fax:386-425-4461
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN20136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine