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Individual

LESLIE A. KONKIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1501 OAKDALE RD STE 301, MODESTO, CA 95355-3382
(209) 571-5071
(209) 577-1157
Mailing address
PO BOX 576158, MODESTO, CA 95357-6158
(209) 605-6469

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
G24534
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G245341
INDIVIDUAL PTAN
CA
05
9703018
CA
Enumeration date
08/14/2006
Last updated
04/05/2020
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