Provider Demographics
NPI:1720064785
Name:BOX, LESLEIGH A (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLEIGH
Middle Name:A
Last Name:BOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LESLEIGH
Other - Middle Name:A
Other - Last Name:SANTONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-5200
Mailing Address - Fax:208-302-5225
Practice Address - Street 1:1880 W JUDITH LANE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5221
Practice Address - Country:US
Practice Address - Phone:208-302-5200
Practice Address - Fax:208-302-5225
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92660207R00000X
IDM-12102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35763Medicare UPIN
033672Medicare ID - Type Unspecified