Provider Demographics
NPI:1568499515
Name:LEACH, W RAFER (MD)
Entity type:Individual
Prefix:DR
First Name:W
Middle Name:RAFER
Last Name:LEACH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 BROADWAY
Mailing Address - Street 2:BLDG A, SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3959
Mailing Address - Country:US
Mailing Address - Phone:303-455-6345
Mailing Address - Fax:303-455-6343
Practice Address - Street 1:1 BROADWAY
Practice Address - Street 2:BLDG A, SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3959
Practice Address - Country:US
Practice Address - Phone:303-455-6345
Practice Address - Fax:303-455-6343
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CO38790207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96833033Medicaid
COH51511Medicare UPIN