Individual
LESLIE B WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
525 COUCH AVE, KIRKWOOD, MO 63122-5536
(314) 966-1500
(314) 966-1681
Mailing address
1836 LACKLAND HILL PKWY, ATTENTION: CREDENTIALING DEPARTMENT, SAINT LOUIS, MO 63146-3572
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
110704
MO
207R00000X
Internal Medicine Physician
110704
MO
208M00000X
Hospitalist Physician
110704
MO
Other
Enumeration date
06/02/2006
Last updated
12/10/2019
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