Provider Demographics
NPI:1962453605
Name:SHURE, LESLEY (MD)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:SHURE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:
Other - Last Name:PADILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9150 HUEBNER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1305
Mailing Address - Country:US
Mailing Address - Phone:210-561-7236
Mailing Address - Fax:210-561-7240
Practice Address - Street 1:9150 HUEBNER RD STE 350
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1305
Practice Address - Country:US
Practice Address - Phone:210-561-7236
Practice Address - Fax:210-561-7240
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055346207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72442Medicare UPIN