Provider Demographics
NPI:1477518538
Name:LEDBETTER, LESLIE SHOOK (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:SHOOK
Last Name:LEDBETTER
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 1:9303 PINECROFT DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3180
Mailing Address - Country:US
Mailing Address - Phone:281-363-5050
Mailing Address - Fax:281-363-5020
Practice Address - Street 1:9303 PINECROFT DR
Practice Address - Street 2:SUITE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3180
Practice Address - Country:US
Practice Address - Phone:281-363-5050
Practice Address - Fax:281-363-5020
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5331207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00052517OtherRAILROAD MEDICARE
TX8A7261OtherBLUE CROSS BLUE SHIELD
7767274OtherAETNA
TX8A7261OtherBLUE CROSS BLUE SHIELD
TX8A7261Medicare ID - Type Unspecified