Provider Demographics
NPI:1669468039
Name:BARKIS, LESLIE A (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:BARKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 SW H K DODGEN LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1814
Mailing Address - Country:US
Mailing Address - Phone:254-298-2682
Mailing Address - Fax:254-778-7197
Practice Address - Street 1:1905 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-298-2682
Practice Address - Fax:254-778-7197
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100550603Medicaid
TX100550603Medicaid
8D4623Medicare ID - Type Unspecified