Provider Demographics
NPI:1457455958
Name:LESLIE, BRUCE W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:LESLIE
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-0158
Mailing Address - Country:US
Mailing Address - Phone:304-257-2527
Mailing Address - Fax:
Practice Address - Street 1:GRANT MEMORIAL DRIVE
Practice Address - Street 2:PIDC BUILDING - SUITE 102
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1716
Practice Address - Country:US
Practice Address - Phone:304-257-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine