Active NPI
Leslie Rainbolt, MD
- Dermatology Physician
- Oklahoma City, OK
National Provider Identifier
1205320579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 19520
- Practice address
- 6821 NW Grand Blvd
Oklahoma City, OK 73116-5413 - Phone
- (405) 821-4112
- NPI assigned
- Jun 19, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 19520 | OK | Primary |
Addresses
Primary practice location
6821 NW Grand Blvd
Oklahoma City, OK 73116-5413
Mailing address
6821 NW Grand Blvd
Oklahoma City, OK 73116-5413
Phone (405) 821-4112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19520 | OK | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529366400000",
"number": "1205320579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6821 NW GRAND BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731165413",
"telephone_number": "405-821-4112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6821 NW GRAND BLVD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731165413",
"telephone_number": "405-821-4112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAINBOLT",
"first_name": "LESLIE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-19",
"last_updated": "2018-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OK",
"license": "19520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.