Provider Demographics
NPI:1720012628
Name:HAMLETT, LESLIE M (DO)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:HAMLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-347-8310
Mailing Address - Fax:417-347-8314
Practice Address - Street 1:932 E 34TH ST STE 1
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3932
Practice Address - Country:US
Practice Address - Phone:417-347-8310
Practice Address - Fax:417-347-8314
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010256207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1720012628Medicaid
KS100425470AMedicaid
OK100846050AMedicaid
KS100425470AMedicaid
MO136570014Medicare PIN