Healthcare Provider Details

I. General information

NPI: 1265486344
Provider Name (Legal Business Name): LESLIE GAIL POER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9700 QUEENSLAND DR
AUSTIN TX
78729-1931
US

IV. Provider business mailing address

9700 QUEENSLAND DR
AUSTIN TX
78729-1931
US

V. Phone/Fax

Practice location:
  • Phone: 512-249-1335
  • Fax: 512-284-7972
Mailing address:
  • Phone: 512-249-1335
  • Fax: 512-284-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number025074
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM3360
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberM3360
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM3360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: