Provider Demographics
NPI:1821050022
Name:ANDERSON, LESLIE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:F
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-266-7265
Mailing Address - Fax:501-266-7269
Practice Address - Street 1:757 SE FRONT STREET
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3025
Practice Address - Country:US
Practice Address - Phone:501-266-7265
Practice Address - Fax:501-266-7269
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC-4445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106683001Medicaid
AR106683001Medicaid
AR50112Medicare PIN