Provider Demographics
NPI:1982628749
Name:EVANS, LEON LOVETT (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:LOVETT
Last Name:EVANS
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 1:2315 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4122
Mailing Address - Country:US
Mailing Address - Phone:303-494-7125
Mailing Address - Fax:303-362-5651
Practice Address - Street 1:2315 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4122
Practice Address - Country:US
Practice Address - Phone:303-494-7125
Practice Address - Fax:303-362-5651
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO234572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry