Provider Demographics
NPI:1669444253
Name:BOYER, LESLIE V (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:V
Last Name:BOYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-7124
Mailing Address - Country:US
Mailing Address - Phone:520-874-3500
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-874-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ189482080T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCGCROtherGROUP MEDICARE NUMBER
AZ295990Medicaid
AZP00244408OtherRR MEDICARE
AZZ37WCGCR06Medicare PIN
AZP00244408OtherRR MEDICARE