Provider Demographics
NPI:1760426746
Name:LESLIE, JOHN T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:LESLIE
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 1:675 HIGHWAY 62 E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3207
Mailing Address - Country:US
Mailing Address - Phone:870-508-7600
Mailing Address - Fax:870-508-7609
Practice Address - Street 1:675 HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3207
Practice Address - Country:US
Practice Address - Phone:870-508-7600
Practice Address - Fax:870-508-7609
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166793001Medicaid
AR5H064OtherBLUECROSS BLUESHIELD
AR166793001Medicaid
AR5H064Medicare PIN