Provider Demographics
NPI:1699056309
Name:REDDELL, LESLIE D (DO,)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:D
Last Name:REDDELL
Suffix:
Gender:F
Credentials:DO,
Other - Prefix:
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Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76101-0865
Mailing Address - Country:US
Mailing Address - Phone:817-632-1900
Mailing Address - Fax:817-632-1904
Practice Address - Street 1:800 8TH AVE STE 306
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2602
Practice Address - Country:US
Practice Address - Phone:822-243-7486
Practice Address - Fax:682-841-0039
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP0783208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0783OtherTEXAS