Provider Demographics
NPI:1427052158
Name:DUNAWAY, LESLIE JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JOSEPH
Last Name:DUNAWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950272
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0272
Mailing Address - Country:US
Mailing Address - Phone:502-238-2801
Mailing Address - Fax:502-238-2835
Practice Address - Street 1:10216 TAYLORSVILLE RD
Practice Address - Street 2:STE 400
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3616
Practice Address - Country:US
Practice Address - Phone:502-267-5456
Practice Address - Fax:502-267-5488
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64233794Medicaid
KY50032124OtherPASSPORT
KY000000708708OtherANTHEM
KYK000010Medicare PIN
KY64233794Medicaid