Individual
LESLIE G WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7201
(214) 648-6400
(214) 648-5461
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(469) 291-3369
(214) 645-0078
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
M3422
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186119703
—
TX
01
—
8EY201
BCBS
TX
01
—
P01509945
RR
TX
Enumeration date
06/22/2006
Last updated
01/10/2020
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