Provider Demographics
NPI:1386636439
Name:KLEBERGER, DAVID W (NP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:KLEBERGER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E HARVARD AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7009
Mailing Address - Country:US
Mailing Address - Phone:303-765-3484
Mailing Address - Fax:303-765-3486
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-765-3484
Practice Address - Fax:303-765-3486
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86336363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COS87495Medicare UPIN