Provider Demographics
NPI:1871552943
Name:TINGLE, LESLIE EARLE (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:EARLE
Last Name:TINGLE
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 1:105 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-2136
Mailing Address - Country:US
Mailing Address - Phone:903-438-3336
Mailing Address - Fax:903-438-3385
Practice Address - Street 1:105 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2136
Practice Address - Country:US
Practice Address - Phone:903-438-3336
Practice Address - Fax:903-438-3385
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4721207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD35999Medicare UPIN
TXPO81141J1Medicaid
TX101688301Medicaid
TXD35999Medicare UPIN
TX81141JMedicare PIN
TX080121067Medicare PIN