Provider Demographics
NPI:1992287551
Name:MOOG, LESLIE ANN (PA-S)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:MOOG
Suffix:
Gender:F
Credentials:PA-S
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Other - Credentials:
Mailing Address - Street 1:3650 PIPER STREET STE A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4692
Mailing Address - Country:US
Mailing Address - Phone:907-339-9455
Mailing Address - Fax:907-339-9445
Practice Address - Street 1:10290 N 92ND ST STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4528
Practice Address - Country:US
Practice Address - Phone:480-905-2015
Practice Address - Fax:480-716-4347
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2025-08-13
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Provider Licenses
StateLicense IDTaxonomies
AZ11053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant