Provider Demographics
NPI:1740692276
Name:TRISTAN, LESLI (MD)
Entity type:Individual
Prefix:DR
First Name:LESLI
Middle Name:
Last Name:TRISTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLI
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1450 N PRESTON RD STE 60
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9890
Mailing Address - Country:US
Mailing Address - Phone:972-316-4555
Mailing Address - Fax:469-802-1548
Practice Address - Street 1:4471 LONG PRAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1755
Practice Address - Country:US
Practice Address - Phone:972-316-4555
Practice Address - Fax:972-316-4550
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5940208D00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice