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Individual
LESLIE NELSON
Active
Individual
LESLIE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L9825
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8U1143
BLUE CROSS BLUE SHIELD
TX
01
—
L9825
STATE LICENSES
TX
Enumeration date
06/07/2006
Last updated
01/23/2015
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