Provider Demographics
NPI:1720012628
Name:HAMLETT, LESLIE M (DO)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:HAMLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-2125
Mailing Address - Country:US
Mailing Address - Phone:573-499-0642
Mailing Address - Fax:573-449-1787
Practice Address - Street 1:1205 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2125
Practice Address - Country:US
Practice Address - Phone:573-499-0642
Practice Address - Fax:573-449-1787
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010256207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100425470AMedicaid
OK100846050AMedicaid
MO1720012628Medicaid
KS100425470AMedicaid
MO136570014Medicare PIN