Provider Demographics
NPI:1265405534
Name:ALLISON, LESLIE JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JAMES
Last Name:ALLISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:STE 1200W
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4624
Mailing Address - Country:US
Mailing Address - Phone:972-720-7820
Mailing Address - Fax:214-775-4502
Practice Address - Street 1:6920 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2206
Practice Address - Country:US
Practice Address - Phone:219-763-8112
Practice Address - Fax:219-764-3251
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111937204Medicaid
TX111937202OtherMEDICAID
IN01072872AOtherSTATE LICENSE
TX164204301Medicaid
TX4119831OtherBLUE LINK #
00U53HOtherBLUE CROSS BLUE SHIELD
TX21643OtherUTMB
TX5272075OtherAETNA
429053OtherWELLCARE
TX121372OtherSUPERIOR HEALTH
429053OtherWELLCARE
TX164204301Medicaid