Provider Demographics
NPI:1619916079
Name:LESLIE R CAPIN MD PC
Entity Type:Organization
Organization Name:LESLIE R CAPIN MD PC
Other - Org Name:DERMATOLOGY ASSOCIATES OF COLORADO PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-340-3378
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:SUITE 060
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-755-0404
Practice Address - Street 1:13701 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6141
Practice Address - Country:US
Practice Address - Phone:303-340-3378
Practice Address - Fax:303-340-3409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04011102Medicaid
COAUA3308OtherBLUE SHIELD
COCJ7354OtherRAILROAD MEDICARE
COAUA3308OtherBLUE SHIELD