Provider Demographics
NPI:1780758714
Name:WHITNEY, LESLIE FIELD (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:FIELD
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2831 FORT MISSOULA RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804
Mailing Address - Country:US
Mailing Address - Phone:406-327-4405
Mailing Address - Fax:406-327-4477
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804
Practice Address - Country:US
Practice Address - Phone:406-327-4405
Practice Address - Fax:406-327-4477
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT6612207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
561OtherBCBS
MT0000018717Medicaid
E45931Medicare UPIN
MT0000018717Medicaid