Provider Demographics
NPI:1588635320
Name:LESLIE, THOMAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
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 1497
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-1497
Mailing Address - Country:US
Mailing Address - Phone:870-741-8559
Mailing Address - Fax:870-741-8423
Practice Address - Street 1:306 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-4453
Practice Address - Country:US
Practice Address - Phone:870-741-8559
Practice Address - Fax:870-741-8423
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101303001Medicaid
ARB90385Medicare UPIN
AR101303001Medicaid