Active NPI
Leslie Shock
- Plastic and Reconstructive Surgery Physician
- Columbia, MO
National Provider Identifier
1649628439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic and Reconstructive Surgery Physician
- License
- 2016017558
- Practice address
- 3220 Bluff Creek Dr
Columbia, MO 65201-3663 - Phone
- (573) 224-8200
- NPI assigned
- Jun 2, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic and Reconstructive Surgery Physician | 2086S0122X | 2016017558 | MO | Primary |
Addresses
Primary practice location
3220 Bluff Creek Dr
Columbia, MO 65201-3663
Mailing address
3220 Bluff Creek Dr
Columbia, MO 65201-3663
Phone (573) 224-8200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053046888 | Other | ORGANIZATION NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016017558 | MO | MD | Plastic and Reconstructive Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680480000000",
"number": "1649628439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3220 BLUFF CREEK DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652013663",
"telephone_number": "573-224-8200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3220 BLUFF CREEK DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652013663",
"telephone_number": "573-224-8200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOCK",
"first_name": "LESLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-06-02",
"last_updated": "2023-04-03",
"certification_date": "2023-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "MO",
"license": "2016017558",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ORGANIZATION NPI",
"identifier": "1053046888",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.