Provider Demographics
NPI:1407825540
Name:LEECH, STEPHEN WESLEY (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WESLEY
Last Name:LEECH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S MCCULLOCH LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-4041
Mailing Address - Country:US
Mailing Address - Phone:719-251-5779
Mailing Address - Fax:
Practice Address - Street 1:4776 EAGLERIDGE CIR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2189
Practice Address - Country:US
Practice Address - Phone:719-553-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO427213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine