Provider Demographics
NPI:1750465001
Name:BAKER, LESLIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7557A DANNAHER DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-3558
Mailing Address - Country:US
Mailing Address - Phone:865-521-8050
Mailing Address - Fax:865-544-5816
Practice Address - Street 1:7557A DANNAHER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3558
Practice Address - Country:US
Practice Address - Phone:865-521-8050
Practice Address - Fax:865-544-5816
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN28974207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710126Medicaid
TNG52928Medicare UPIN
TN3710126Medicaid