Landrum, Leslie Grace

Landrum, Leslie Grace is an individual health care provider with primary practice located at 1100 N College Ave , Fayetteville AR 72703-1944. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine. Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine is her primary health care specialty. Landrum, Leslie Grace can be contacted via phone (479) 443-4301.

Contact Information

Primary practice address
1100 N College Ave Fayetteville AR 72703-1944
Phone: (479) 443-4301
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X C7717 Arkansas
Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine 207RH0002X C7717 Arkansas

Profile Details

NPI number 1104842483
LBN Legal business name Landrum, Leslie Grace
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 13th, 2006
Last updated Mar 30th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104842483 NPPES
Missouri MEDICAID 1104842483
Missouri MEDICAID 121329001
Missouri MEDICAID 100077480A

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