Provider Demographics
NPI:1457354896
Name:ESTEP, LESLIE A (MD)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:A
Last Name:ESTEP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:M
Other - Last Name:AMENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E. KINCAID STREET
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:227 FREEWAY DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-814-5550
Practice Address - Fax:360-814-5591
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032199207Q00000X, 207QH0002X
WAMD0032199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8185985Medicaid
WA014683OtherL&I
WA014683OtherL&I
WAAB19768Medicare ID - Type Unspecified
WAG8906816Medicare PIN