Provider Demographics
NPI:1699769083
Name:PERRY, LESLIE DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:DAVID
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:DAVID
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4700 WOODMERE BLVD.
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-273-9700
Mailing Address - Fax:334-273-9788
Practice Address - Street 1:4700 WOODMERE BLVD.
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-273-9700
Practice Address - Fax:334-273-9788
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMO29166208000000X
AL19198208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4095192OtherBCBS
TNQ007873Medicaid