Provider Demographics
NPI:1831197847
Name:STORK, LESLIE F (MD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:F
Last Name:STORK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8637 FREDERICKSBURG ROAD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240
Mailing Address - Country:US
Mailing Address - Phone:210-949-4179
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:32665 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 202
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3124
Practice Address - Country:US
Practice Address - Phone:830-980-8433
Practice Address - Fax:830-980-8442
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM7660207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E39198Medicare UPIN
TX8K9723Medicare PIN
150240EMedicare ID - Type Unspecified