Basic Information
Provider Information
NPI: 1003140963
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARR
FirstName: LESLIE
MiddleName: ERIN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BLIHOVDE
OtherFirstName: LESLIE
OtherMiddleName: ERIN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 1
Mailing Information
Address1: 805 N KENTUCKY AVE
Address2:  
City: WEST PLAINS
State: MO
PostalCode: 657752022
CountryCode: US
TelephoneNumber: 4172562111
FaxNumber: 4172564858
Practice Location
Address1: 805 N KENTUCKY AVE
Address2:  
City: WEST PLAINS
State: MO
PostalCode: 657752022
CountryCode: US
TelephoneNumber: 4172562111
FaxNumber: 4172564858
Other Information
ProviderEnumerationDate: 09/25/2009
LastUpdateDate: 12/29/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME103823FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
ME10382301FLFLORIDA MEDICAL LICENSEOTHER
100314096305MO MEDICAID
200903907401MOMISSOURI MEDICAL LICENSEOTHER


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