Individual
LESLIE SHOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3220 BLUFF CREEK DR, COLUMBIA, MO 65201-3663
(573) 224-8200
Mailing address
3220 BLUFF CREEK DR, COLUMBIA, MO 65201-3663
(573) 224-8200
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
2016017558
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053046888
ORGANIZATION NPI
—
Enumeration date
06/02/2016
Last updated
04/03/2023
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