Healthcare Provider Details

I. General information

NPI: 1548333669
Provider Name (Legal Business Name): LESLIE KEITH SHOKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 N BRISTOL ST H2
SANTA ANA CA
92706-1457
US

IV. Provider business mailing address

2703 N BRISTOL ST H2
SANTA ANA CA
92706-1457
US

V. Phone/Fax

Practice location:
  • Phone: 714-648-0335
  • Fax: 714-648-0348
Mailing address:
  • Phone: 714-648-0335
  • Fax: 714-648-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA051726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: