Individual
DR. LESLIE GRACE LANDRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 N COLLEGE AVE, FAYETTEVILLE, AR 72703-1944
(479) 443-4301
Mailing address
3232 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4005
(479) 750-7799
(479) 751-5744
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C7717
AR
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
C7717
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100077480A
—
OK
05
—
1104842483
—
MO
05
—
121329001
—
AR
Enumeration date
07/13/2006
Last updated
03/30/2020
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