Provider Demographics
NPI:1790053569
Name:WALTMAN, LESLIE RAY III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:RAY
Last Name:WALTMAN
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1308 E BRIGGS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1919
Mailing Address - Country:US
Mailing Address - Phone:660-415-5215
Mailing Address - Fax:
Practice Address - Street 1:8717 W 110TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2144
Practice Address - Country:US
Practice Address - Phone:205-474-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-115596163W00000X
MO2012006261367500000X
MO2011040586163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse