Provider Demographics
NPI:1578573325
Name:SCHMITZ, LESLEY ANN (DO)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ANN
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 BELLAIRE DR S
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-1889
Mailing Address - Country:US
Mailing Address - Phone:817-735-2235
Mailing Address - Fax:817-735-2480
Practice Address - Street 1:7003 CHAD COLLEY BLVD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-3000
Practice Address - Country:US
Practice Address - Phone:479-431-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7877204D00000X
ARE-10709204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198638201Medicaid
TX8CA886OtherBCBS
TX8L3620Medicare PIN