Provider Demographics
NPI:1841581071
Name:SELBY, LEAH KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:KATHRYN
Last Name:SELBY
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 1:2637 MIDPOINT DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4408
Mailing Address - Country:US
Mailing Address - Phone:970-488-1666
Mailing Address - Fax:307-432-6634
Practice Address - Street 1:2637 MIDPOINT DR STE B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4408
Practice Address - Country:US
Practice Address - Phone:970-488-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10182A207R00000X
CODR.0061092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine