Provider Demographics
NPI:1306093877
Name:DALLY, LESLIE M (DO)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:DALLY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:944 SEARCY WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7168
Mailing Address - Country:US
Mailing Address - Phone:270-467-7180
Mailing Address - Fax:270-904-2862
Practice Address - Street 1:944 SEARCY WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7168
Practice Address - Country:US
Practice Address - Phone:270-467-7180
Practice Address - Fax:270-904-2862
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY033482083A0300X
TN44182083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1598706665OtherBCBS OF KS
KS173403Medicare PIN
KS016501Medicare PIN
KS1780623827Medicaid