Basic Information
| Provider Information | |||||||||
| NPI: | 1295779809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LESLIE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | BRENT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 6TH AVENUE NORTH | ||||||||
| Address2: | CENTRACARE CLINIC RIVER CAMPUS | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202523342 | ||||||||
| FaxNumber: | 3202523501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 6TH AVENUE NORTH | ||||||||
| Address2: | CENTRACARE CLINIC RIVER CAMPUS | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202523342 | ||||||||
| FaxNumber: | 3202523501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 42685 | MN | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.