Provider Demographics
NPI:1669476172
Name:WARSHAW, LESLEY M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:M
Last Name:WARSHAW
Suffix:JR
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 1:2108 TEXAS AVE
Mailing Address - Street 2:STE 3061
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3903
Mailing Address - Country:US
Mailing Address - Phone:318-443-8380
Mailing Address - Fax:318-443-8761
Practice Address - Street 1:2108 TEXAS AVE
Practice Address - Street 2:STE 3061
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3903
Practice Address - Country:US
Practice Address - Phone:318-443-8380
Practice Address - Fax:318-443-8761
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1372781Medicaid
LA5K669Medicare ID - Type Unspecified
LA1372781Medicaid