Provider Demographics
NPI:1487794616
Name:LESLIE A STEWART MD PC
Entity type:Organization
Organization Name:LESLIE A STEWART MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-756-5281
Mailing Address - Street 1:8200 E BELLEVIEW AVE STE 404C
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2807
Mailing Address - Country:US
Mailing Address - Phone:303-761-0906
Mailing Address - Fax:303-761-0907
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-761-0906
Practice Address - Fax:303-761-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COST151308OtherBLUE SHIELD
COC151308Medicare PIN