Provider Demographics
NPI:1356520985
Name:LESLIE CAMPBELL, D.P.M., P.A.
Entity type:Organization
Organization Name:LESLIE CAMPBELL, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-747-5800
Mailing Address - Street 1:1105 CENTRAL EXPY N
Mailing Address - Street 2:SUITE 2240
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6103
Mailing Address - Country:US
Mailing Address - Phone:972-747-5800
Mailing Address - Fax:972-747-5831
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 2240
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-747-5800
Practice Address - Fax:972-747-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12516Medicare UPIN
TX00W349Medicare PIN