Provider Demographics
NPI:1821006123
Name:LEO, PAUL STEFAN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:STEFAN
Last Name:LEO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 GRANT ST
Mailing Address - Street 2:STE 200
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4384
Mailing Address - Country:US
Mailing Address - Phone:303-287-2800
Mailing Address - Fax:303-287-7357
Practice Address - Street 1:9005 GRANT ST STE 200
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4384
Practice Address - Country:US
Practice Address - Phone:303-287-2800
Practice Address - Fax:303-287-7357
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31742208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01317429Medicaid
CO412828Medicare ID - Type Unspecified
COE48883Medicare UPIN