MEDICARE: SHELLY L LEEDS-RICHTER 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	207V00000X	Obstetrics & Gynecology Physician	L1642	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8A6812	OTHER	TX	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1861494171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY L LEEDS-RICHTER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4048
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4048
Country	:	US
Telephone Number	:	713-512-7000
Fax Number	:	713-512-7677

Provider Business Practice Location Address
First Line	:	7900 FANNIN ST
Second Line	:	SUITE 4000
City	:	HOUSTON
State	:	TX
Zip	:	77054-2934
Country	:	US
Telephone Number	:	713-512-7000
Fax Number	:	713-512-7677

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/30/2014

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