Provider Demographics
NPI:1790973717
Name:DR. LESLIE J. ALLISON
Entity Type:Organization
Organization Name:DR. LESLIE J. ALLISON
Other - Org Name:MONARCH MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-361-0304
Mailing Address - Street 1:19026 WINDSOR LAKES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-3307
Mailing Address - Country:US
Mailing Address - Phone:832-361-0304
Mailing Address - Fax:888-753-5616
Practice Address - Street 1:19026 WINDSOR LAKES DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-3307
Practice Address - Country:US
Practice Address - Phone:832-361-0304
Practice Address - Fax:888-753-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164204301Medicaid
TX00275WMedicare PIN