Provider Demographics
NPI:1245291491
Name:BOWDRE, LESLEY ALISON (PA)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:ALISON
Last Name:BOWDRE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8813
Mailing Address - Country:US
Mailing Address - Phone:970-877-1087
Mailing Address - Fax:970-871-2550
Practice Address - Street 1:1024 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8813
Practice Address - Country:US
Practice Address - Phone:970-877-1087
Practice Address - Fax:970-871-2550
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71255389Medicaid
1866OtherSTATE OF COLO LICENSE
MB1081607OtherDEA COLORADO
CO71255389Medicaid
1866OtherSTATE OF COLO LICENSE