Provider Demographics
NPI:1962562579
Name:CHUPP, LESLIE E (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:E
Last Name:CHUPP
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 1:2420 W PIERCE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3518
Mailing Address - Country:US
Mailing Address - Phone:432-262-3822
Mailing Address - Fax:
Practice Address - Street 1:1211 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6158
Practice Address - Country:US
Practice Address - Phone:432-262-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6119207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF27869Medicare UPIN
TX128609806Medicaid
TX8BX812OtherBC/BS
TXF27869Medicare UPIN