Individual
LESLIE LEE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 DELTA WATERS RD, SUITE 107, MEDFORD, OR 97504-9114
(541) 858-2515
(541) 858-2514
Mailing address
815 N CENTRAL AVE, SUITE C, MEDFORD, OR 97501-5873
(541) 734-9030
(541) 734-9885
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD11227
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113738
—
OR
01
—
MD11227
MEDICAL LICENSE
—
Enumeration date
12/12/2006
Last updated
03/07/2023
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