Provider Demographics
NPI:1699212597
Name:LESLIE K MESERVE MD INC
Entity Type:Organization
Organization Name:LESLIE K MESERVE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MESERVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-558-0501
Mailing Address - Street 1:400 NEWPORT CENTER DR STE 310
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7636
Mailing Address - Country:US
Mailing Address - Phone:949-558-0501
Mailing Address - Fax:949-558-0502
Practice Address - Street 1:400 NEWPORT CENTER DR STE 310
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7636
Practice Address - Country:US
Practice Address - Phone:949-558-0501
Practice Address - Fax:949-558-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty