MEDICARE: DR. LESLIE L WELLS M.D.

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	208000000X	Pediatrics Physician	L1101	TX

General Provider Information

NPI Number	:	1528067907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE L WELLS M.D.

Provider Business Mailing Address
First Line	:	6618 SITIO DEL RIO BLVD
Second Line	:	BUILDING A SUITE 101
City	:	AUSTIN
State	:	TX
Zip	:	78730-1143
Country	:	US
Telephone Number	:	512-241-1370
Fax Number	:	512-241-1374

Provider Business Practice Location Address
First Line	:	6618 SITIO DEL RIO BLVD
Second Line	:	BUILDING A SUITE 101
City	:	AUSTIN
State	:	TX
Zip	:	78730-1143
Country	:	US
Telephone Number	:	512-241-1370
Fax Number	:	512-241-1374

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/08/2012

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