Provider Demographics
NPI:1053492413
Name:LENERT, LESLIE ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANDREW
Last Name:LENERT
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 1:30 N 1900 E
Mailing Address - Street 2:ROOM 4C104
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-2406
Mailing Address - Country:US
Mailing Address - Phone:801-581-7906
Mailing Address - Fax:801-581-5393
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:ROOM 4C104
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2406
Practice Address - Country:US
Practice Address - Phone:801-581-7906
Practice Address - Fax:801-581-5393
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG060812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine