Provider Demographics
NPI:1598761348
Name:FLEMING, JOHN LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:FLEMING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3630 SINTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5072
Mailing Address - Country:US
Mailing Address - Phone:719-471-7206
Mailing Address - Fax:719-471-8452
Practice Address - Street 1:3630 SINTON RD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5072
Practice Address - Country:US
Practice Address - Phone:719-471-7206
Practice Address - Fax:719-471-8452
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01201532Medicaid
CO01201532Medicaid
CO01201532Medicaid