Provider Demographics
NPI:1669419990
Name:LESLIE, LARRY MILFORD II (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:MILFORD
Last Name:LESLIE
Suffix:II
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 1:399 9TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5820
Mailing Address - Country:US
Mailing Address - Phone:239-624-4200
Mailing Address - Fax:239-624-4201
Practice Address - Street 1:399 9TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5820
Practice Address - Country:US
Practice Address - Phone:239-624-4200
Practice Address - Fax:239-624-4201
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062082A207RC0000X, 207RI0011X
KY34948207RC0000X, 207RI0011X
FLME125405207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZU6F4OtherBCBS
FL016303900Medicaid
FLP01626269OtherRAILROAD MEDICARE
FLIL736ZOtherMEDICARE
IN251440EMedicare PIN
FLZU6F4OtherBCBS
KY00312017Medicare PIN
FL016303900Medicaid
KY00310017Medicare PIN
FLIL736ZOtherMEDICARE
KY00313017Medicare PIN
IN228550CMedicare PIN
FLP01626269OtherRAILROAD MEDICARE
KY00308017Medicare PIN
FLIL736ZMedicare PIN
KYP00612952Medicare PIN
KY00546058Medicare Oscar/Certification
KYP00336130OtherRAILROAD MEDICARE
KY00308017Medicare PIN
IN228550CMedicare PIN
IN2008000030Medicaid
KY00312017Medicare PIN
KY00311017Medicare PIN