Provider Demographics
NPI:1356328835
Name:WELBORNE, LESLIE SKINNER (MD)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:SKINNER
Last Name:WELBORNE
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:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8450
Mailing Address - Fax:
Practice Address - Street 1:5757 WARREN PARKWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4777
Practice Address - Country:US
Practice Address - Phone:972-731-6565
Practice Address - Fax:972-731-6570
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8842207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167870801Medicaid
TX167870801Medicaid
8C2594Medicare PIN