Provider Demographics
NPI:1841281318
Name:DRUMMOND-BORG, LESLEY M (MD)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:M
Last Name:DRUMMOND-BORG
Suffix:
Gender:F
Credentials:MD
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:750 8TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2500
Practice Address - Country:US
Practice Address - Phone:682-885-2170
Practice Address - Fax:817-335-8277
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4908207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138239214OtherCSHCN
TX138239219Medicaid
TX138239218Medicaid
TX138239220OtherCSHCN
TX0097AXOtherBCBSTX GRP NUMBER
TX138239213Medicaid
TX138239215Medicaid
TX138239216OtherCSHCN
TX138239221OtherCSHCN
TX138239217Medicaid
1750369203OtherGROUP NPI NUMBER
TX138239213Medicaid