Edgcomb, Leslie Paul

Edgcomb, Leslie Paul is an individual health care provider with primary practice located at 5668 E State St , Rockford IL 61108-2464. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as his primary health care specialty. Edgcomb, Leslie Paul can be contacted via phone (815) 229-7580.

Contact Information

Primary practice address
5668 E State St Rockford IL 61108-2464
Phone: (815) 229-7580
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 036072104 Illinois

Profile Details

NPI number 1629014022
LBN Legal business name Edgcomb, Leslie Paul
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Oct 6th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629014022 NPPES
Illinois MEDICAID 036072104
Illinois MEDICAID 30696600
Illinois Other 020017328

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