Provider Demographics
NPI:1063492841
Name:LEEVER, JOHN TERRY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TERRY
Last Name:LEEVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2131
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-2131
Mailing Address - Country:US
Mailing Address - Phone:970-256-6440
Mailing Address - Fax:
Practice Address - Street 1:2021 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2980
Practice Address - Country:US
Practice Address - Phone:970-256-6440
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO232672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01232677Medicaid
COE46944Medicare UPIN
COC3228Medicare ID - Type Unspecified