Provider Demographics
NPI:1194777813
Name:CAMPBELL, LESLIE (DPM)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RAINTREE CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4902
Mailing Address - Country:US
Mailing Address - Phone:972-332-8110
Mailing Address - Fax:972-332-8109
Practice Address - Street 1:1111 RAINTREE CIR STE 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4902
Practice Address - Country:US
Practice Address - Phone:972-332-8110
Practice Address - Fax:972-332-8109
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F21939Medicare PIN
TXT12516Medicare UPIN
TX00W349Medicare ID - Type Unspecified