MEDICARE: GEORGE LEOR SHASHOUA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	J2982	TX

General Provider Information

NPI Number	:	1245379551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE LEOR SHASHOUA MD

Provider Business Mailing Address
First Line	:	12319 N MOPAC EXPY
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78758-2414
Country	:	US
Telephone Number	:	512-973-8276
Fax Number	:	512-973-3036

Provider Business Practice Location Address
First Line	:	12319 N MOPAC EXPY
Second Line	:	SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78758-2414
Country	:	US
Telephone Number	:	512-973-8276
Fax Number	:	512-973-3036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/07/2025

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