Provider Demographics
NPI:1730140211
Name:GLOVER, LESLEY NICHOLE (MD)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:NICHOLE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 ROYAL PALM BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:561-791-3452
Mailing Address - Fax:561-791-6970
Practice Address - Street 1:10115 FOREST HILL BLVD
Practice Address - Street 2:STE 200
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-793-5155
Practice Address - Fax:561-793-4375
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SG076277OtherVISTA
297824OtherAVMED
3690430OtherAETNA
50298OtherBCBS
0711321OtherCIGNA
50298OtherBCBS
297824OtherAVMED