Provider Demographics
NPI:1932289931
Name:MILLER, LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:MILLER WEERTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MRS
Mailing Address - Street 1:1801 NW MARKET STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3909
Mailing Address - Country:US
Mailing Address - Phone:206-782-9336
Mailing Address - Fax:207-781-8713
Practice Address - Street 1:1801 NW MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3909
Practice Address - Country:US
Practice Address - Phone:206-782-9336
Practice Address - Fax:207-781-8713
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029994207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8747OtherINTERNAL ID-MOTOR VEHICLE ID
WA8140436Medicaid
WA000108087Medicare PIN
WAAB25017Medicare PIN
8747OtherINTERNAL ID-MOTOR VEHICLE ID