Individual
RICHARD LESLIE SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4371 NARROW LANE RD, MONTGOMERY, AL 36116-2971
(334) 613-3680
(334) 613-3685
Mailing address
4371 NARROW LANE RD, MONTGOMERY, AL 36116-2975
(334) 613-3680
(334) 613-3685
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO898
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009937494
—
AL
01
—
0403254
UNITED HEALTHCARE
AL
01
—
051542076
BCBS PROVIDER #
AL
01
—
051557580
MEDICARE PROVIDER #
AL
01
—
630813275
COMMERCIAL
AL
Enumeration date
05/02/2006
Last updated
03/27/2008
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