Provider Demographics
NPI:1760774798
Name:COLIP, LESLIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:COLIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63142 RIVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-6211
Mailing Address - Country:US
Mailing Address - Phone:503-961-5314
Mailing Address - Fax:
Practice Address - Street 1:10101 SE MAIN ST STE 2011
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2457
Practice Address - Country:US
Practice Address - Phone:503-261-6912
Practice Address - Fax:503-251-6357
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD463319207RE0101X
ORMD202937207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism