Provider Demographics
NPI:1336235456
Name:YONEMOTO, LESLIE T (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:T
Last Name:YONEMOTO
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 1:2525 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7227
Mailing Address - Country:US
Mailing Address - Phone:405-607-4520
Mailing Address - Fax:405-607-4525
Practice Address - Street 1:5901 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2015
Practice Address - Country:US
Practice Address - Phone:405-773-6700
Practice Address - Fax:405-720-3910
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA513552085R0001X
OK304592085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00756929OtherRR MEDICARE
CAP00756929OtherRR MEDICARE
CACH135YMedicare PIN