Provider Demographics
NPI:1710992185
Name:BORNFLETH, LESLIE R (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:BORNFLETH
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 1:732 SUMMITVIEW AVE
Mailing Address - Street 2:#621
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3032
Mailing Address - Country:US
Mailing Address - Phone:509-573-3448
Mailing Address - Fax:509-574-4481
Practice Address - Street 1:111 S 11TH AVE
Practice Address - Street 2:SUITE 321
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3242
Practice Address - Country:US
Practice Address - Phone:509-248-3954
Practice Address - Fax:509-248-3955
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014255207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8119208Medicaid
A06873Medicare UPIN
G8800144Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER