Provider Demographics
NPI:1265822308
Name:LEVESQUE, DEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:LEVESQUE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 GOLDEN RIDGE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9541
Mailing Address - Country:US
Mailing Address - Phone:303-233-1223
Mailing Address - Fax:303-233-8755
Practice Address - Street 1:660 GOLDEN RIDGE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9541
Practice Address - Country:US
Practice Address - Phone:303-233-1223
Practice Address - Fax:303-233-8755
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-05501363AS0400X
SC2492363AS0400X
COPA.0004976363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2651PAMedicaid
SC2651PAMedicaid