Individual
LESLIE PAUL EDGCOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5668 E STATE ST, ROCKFORD, IL 61108-2464
(815) 229-7580
Mailing address
5668 E STATE ST, ROCKFORD, IL 61108-2464
(815) 229-7580
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
036072104
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020017328
RAILROAD MEDICARE
—
05
—
036072104
—
IL
05
—
30696600
—
WI
Enumeration date
06/22/2006
Last updated
10/06/2015
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