Provider Demographics
NPI:1710902440
Name:MCGOWAN, LESLIE R (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:MCGOWAN
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 1:6027 WALNUT GROVE SUITE 319
Mailing Address - Street 2:THE UROLOGY GROUP PC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2128
Mailing Address - Country:US
Mailing Address - Phone:901-767-8158
Mailing Address - Fax:901-767-1555
Practice Address - Street 1:6027 WALNUT GROVE SUITE 319
Practice Address - Street 2:THE UROLOGY GROUP PC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2128
Practice Address - Country:US
Practice Address - Phone:901-767-8158
Practice Address - Fax:901-767-1555
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014127208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2569882OtherCIGNA
TN0063951OtherBCBS
4025446OtherAETNA
MS0340OtherBCBS
340005959OtherRR MEDICARE
AR112244001Medicaid
AR81493OtherBCBS
B04793Medicare UPIN
TN3198335Medicare PIN