Provider Demographics
NPI:1629013388
Name:LEO, JAN ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:ELIZABETH
Last Name:LEO
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 1:5579 S CURTICE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-1105
Mailing Address - Country:US
Mailing Address - Phone:303-730-0205
Mailing Address - Fax:303-730-1416
Practice Address - Street 1:5579 S CURTICE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-1105
Practice Address - Country:US
Practice Address - Phone:303-730-0205
Practice Address - Fax:303-730-1416
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25452207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01254523Medicaid
COD24636Medicare UPIN
CO01254523Medicaid