Provider Demographics
NPI:1679669089
Name:SHAUF, LESLIE RALPH (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:RALPH
Last Name:SHAUF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3709
Mailing Address - Country:US
Mailing Address - Phone:806-792-8751
Mailing Address - Fax:806-792-8754
Practice Address - Street 1:6505 2ND STREET
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3709
Practice Address - Country:US
Practice Address - Phone:806-792-8751
Practice Address - Fax:806-792-8754
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8833207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC96754Medicare UPIN
TX86V370Medicare ID - Type Unspecified