LESLIE LEE MCCULLOUGH (NPI# 1912068289) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912068289 |
| Entity Type | Individual |
| Full Name | LESLIE LEE MCCULLOUGH |
| Credential | M.D. |
| Practice Address |
1600 Delta Waters Rd Suite 107 Medford OR 97504-9114 |
| Mailing Address |
815 N Central Ave Suite C Medford OR 97501-5873 |
| Practice Telephone | 5418582515 |
| Practice Fax Number | 5418582514 |
| Mailing Telephone | 5417349030 |
| Mailing Fax Number | 5417349885 |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2017-03-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD11227 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | AM2906797 | 01 | |
| MEDICAL LICENSE | MD11227 | 01 | |
| OR | 113738 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184763955 | Leslie Marie Mccullough | Psychologist | 1212 Sw Mulvane St, Topeka, KS 66604-1442 | 2007-02-06 |
| Street Address |
1600 DELTA WATERS RD SUITE 107 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-9114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538166756 | James D Dowd | Orthopaedic Surgery | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2005-07-01 |
| 1053557413 | Kathryn A Warner | Registered Nurse | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2009-01-06 |
| 1366699803 | Robert R. Hoffner | Physician Assistant | 1600 Delta Waters Rd, 107, Medford, OR 97504-9114 | 2008-08-27 |
| 1023147451 | John D Berlingeri | Physician Assistant | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2007-03-02 |
| 1982731618 | Allen Lewis Hayter | Physician Assistant | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2007-02-28 |
| 1588717979 | Maria Dawn Miller | Family Medicine | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2007-01-19 |
| 1972656395 | Mona J. Mcardle | Emergency Medicine | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2007-01-19 |
| 1376696732 | Thomas Peter Penner | Family Medicine | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2007-01-19 |
| 1477603454 | Jeffrey Gray Williams | Emergency Medicine | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2007-01-11 |
| 1023165362 | Madhavi S Deshmukh | Physician Assistant | 1600 Delta Waters Rd, Suite 107, Medford, OR 97504-9114 | 2007-01-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346847332 | Jasmine Barnhart | Family Medicine | 1935 Canyon Ave, Medford, OR 97504-2128 | 2020-10-03 |
| 1831742667 | Mallory Marie Morton | Family Medicine | 429 Main St # 3, Medford, MA 02155-6571 | 2019-07-21 |
| 1841619418 | Andrew Thomas Gomez | Family Medicine | 131 Rte 70 W, Ste 100, Medford, NJ 08055 | 2014-04-10 |
| 1992140313 | Stephanie Guido | Family Medicine | 128 Route 70 Ste Aandb, Medford, NJ 08055-2371 | 2013-04-30 |
| 1316214281 | Carl Russell Griesser | Family Medicine | 555 Black Oak Drive, Suite 100, Medford Medical Clinic, Medford, OR 97504 | 2011-11-21 |
| 1649591223 | Wesley T Ramoso | Family Medicine | 3225 Hillcrest Park Dr, Medford, OR 97504-7657 | 2010-06-17 |
| 1891945812 | Amy Holmes Medical Services Plc | Family Medicine | 102 E Cherokee, Medford, OK 73759-1210 | 2008-09-26 |
| 1972793370 | Sowmya Reddy Thadisina | Family Medicine | 101 Main St Ste 214, Medford, MA 02155-4530 | 2007-07-31 |
| 1689890667 | James K Robinson II | Family Medicine | W5238 Jolly Ave, Medford, WI 54451-9303 | 2007-04-18 |
| 1316160658 | Island Medical of Medford, LLP | Family Medicine | 1647 Route 112, Medford, NY 11763-3635 | 2007-04-11 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.