Provider Demographics
NPI:1164523197
Name:HUFFMAN-DILG, LESLEY (PA)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:HUFFMAN-DILG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:660 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8512
Mailing Address - Country:US
Mailing Address - Phone:314-448-3791
Mailing Address - Fax:314-996-7658
Practice Address - Street 1:3009 N BALLAS RD STE 226A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2337
Practice Address - Country:US
Practice Address - Phone:314-996-5900
Practice Address - Fax:314-996-5910
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005004539363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
196559OtherBLUE CROSS OF MO
196559OtherBLUE CROSS OF MO
000097205Medicare ID - Type Unspecified