Provider Demographics
NPI:1396878286
Name:LESLEY M. WARSHAW, JR. M.D APMC
Entity type:Organization
Organization Name:LESLEY M. WARSHAW, JR. M.D APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:WARSHAW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-443-8380
Mailing Address - Street 1:2108 TEXAS AVE STE 3061
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3903
Mailing Address - Country:US
Mailing Address - Phone:318-443-8380
Mailing Address - Fax:318-443-6079
Practice Address - Street 1:2108 TEXAS AVE STE 3061
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3903
Practice Address - Country:US
Practice Address - Phone:318-443-8380
Practice Address - Fax:318-443-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1372781Medicaid
LA1372781Medicaid
LAC067200Medicare UPIN