Provider Demographics
NPI:1205811395
Name:FLEISCHER, LESLIE R (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:R
Last Name:FLEISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:CARDIOLOGY DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-863-8294
Mailing Address - Fax:850-863-8228
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:CARDIOLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8294
Practice Address - Fax:850-863-8228
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77743207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2288ZMedicare ID - Type Unspecified
B35193Medicare UPIN