Healthcare Provider Details

I. General information

NPI: 1245379551
Provider Name (Legal Business Name): GEORGE LEOR SHASHOUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12319 N MOPAC EXPY SUITE 200
AUSTIN TX
78758-2414
US

IV. Provider business mailing address

12319 N MOPAC EXPY SUITE 200
AUSTIN TX
78758-2414
US

V. Phone/Fax

Practice location:
  • Phone: 512-973-8276
  • Fax: 512-973-3036
Mailing address:
  • Phone: 512-973-8276
  • Fax: 512-973-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberJ2982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: