Provider Demographics
NPI:1245379551
Name:SHASHOUA, GEORGE LEOR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:LEOR
Last Name:SHASHOUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12319 N MOPAC EXPY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2414
Mailing Address - Country:US
Mailing Address - Phone:512-973-8276
Mailing Address - Fax:512-973-3036
Practice Address - Street 1:12319 N MOPAC EXPY
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2414
Practice Address - Country:US
Practice Address - Phone:512-973-8276
Practice Address - Fax:512-973-3036
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology