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NPI Code Detail

MEDICARE: DR. JESSICA LEIGH SHELLOCK M.D.

MEDICARE: DR. JESSICA LEIGH SHELLOCK 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
1207XS0117XOrthopaedic Surgery of the Spine PhysicianM9650TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M9650OTHERTXTEXAS MEDICAL LICENSE

General Provider Information

NPI Number : 1700975398
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA LEIGH SHELLOCK M.D.
Provider Business Mailing Address
First Line : 6020 W PARKER RD STE 200
Second Line :
City : PLANO
State : TX
Zip : 75093-8172
Country : US
Telephone Number : 972-473-3947
Fax Number :
Provider Business Practice Location Address
First Line : 6020 W PARKER RD STE 200
Second Line :
City : PLANO
State : TX
Zip : 75093-8172
Country : US
Telephone Number : 972-608-5000
Fax Number : 972-473-3929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 06/29/2020

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