Individual
LESLIE K WISCOMBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10000 E 66TH TER, RAYTOWN, MO 64133-5251
(816) 737-1037
(816) 737-0477
Mailing address
10000 E 66TH TER, RAYTOWN, MO 64133-5251
(816) 737-1037
(816) 737-0477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33655
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001310D
—
KS
05
—
100001310E
—
KS
05
—
100001310F
—
KS
05
—
1235123126
—
MO
05
—
240345017
—
MO
Enumeration date
09/07/2005
Last updated
07/17/2009
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