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LESLIE E FULLER DO

>> Anesthesiology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1962489229

Individual Registrant:
 LESLIE E FULLER DO
Gender: F
Sole Proprietor

Location and contact information for practice:
1906 BLAKE AVE  GLENWOOD SPGS, CO 81601-4227 US
Tel: 970-945-6535  Fax: --

Contact information for business:
PO BOX 932  GLENWOOD SPGS, CO 81602-0932 US
Tel: 970-945-1443  Fax: --

Registration Information:
NPI: 1962489229
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
CO32980

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
01329804CO05
BLUE CROSSFU1232201




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