Provider Demographics
NPI:1871023432
Name:LESLIE A. STOREY, M.D., INC.
Entity Type:Organization
Organization Name:LESLIE A. STOREY, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-472-7546
Mailing Address - Street 1:4388 N WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-3628
Mailing Address - Country:US
Mailing Address - Phone:559-476-0515
Mailing Address - Fax:
Practice Address - Street 1:7777 N. INGRAM AVE.
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6281
Practice Address - Country:US
Practice Address - Phone:559-472-7546
Practice Address - Fax:559-385-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81742207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty