Provider Demographics
NPI:1770716938
Name:SLACK, LEIGH-ANNE LINDENMUTH (DO)
Entity type:Individual
Prefix:
First Name:LEIGH-ANNE
Middle Name:LINDENMUTH
Last Name:SLACK
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:2817 REILLY ROAD
Mailing Address - Street 2:MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:2817 REILLY ROAD
Practice Address - Street 2:MCXC-COD CREDENTIALS WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2014-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0102202732207Q00000X, 207P00000X
NC192120207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine