Provider Demographics
NPI:1750611406
Name:LELAND, EDWARD HARRY
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:HARRY
Last Name:LELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 FARRADAY RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8841
Mailing Address - Country:US
Mailing Address - Phone:970-259-2580
Mailing Address - Fax:
Practice Address - Street 1:1110 FARRADAY RD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-8841
Practice Address - Country:US
Practice Address - Phone:970-259-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2968171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor