Provider Demographics
NPI:1336215490
Name:DESSIEUX, LESLY (DO)
Entity Type:Individual
Prefix:
First Name:LESLY
Middle Name:
Last Name:DESSIEUX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10920 FRY RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4061
Mailing Address - Country:US
Mailing Address - Phone:832-220-5103
Mailing Address - Fax:281-256-8719
Practice Address - Street 1:10920 FRY RD
Practice Address - Street 2:STE 100
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4061
Practice Address - Country:US
Practice Address - Phone:832-220-5103
Practice Address - Fax:281-256-8719
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0372OtherMEDICAL LICENSE