Provider Demographics
NPI:1114029683
Name:BULMAHN, LORA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:LEIGH
Last Name:BULMAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 CIMARRON PL
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-6079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 W SOUTH BOULDER RD
Practice Address - Street 2:SUITE #1
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1159
Practice Address - Country:US
Practice Address - Phone:303-666-4949
Practice Address - Fax:303-666-4950
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COIO2869Medicare UPIN
COC531188Medicare ID - Type Unspecified