Provider Demographics
NPI:1801873740
Name:QUE, LEON TAN JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:TAN
Last Name:QUE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3445 PENROSE PL
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1878
Mailing Address - Country:US
Mailing Address - Phone:303-442-2288
Mailing Address - Fax:303-444-5551
Practice Address - Street 1:3445 PENROSE PL
Practice Address - Street 2:SUITE 130
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1878
Practice Address - Country:US
Practice Address - Phone:303-442-2288
Practice Address - Fax:303-444-5551
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CODR-498282084P0800X
MDD68063208D00000X, 2084P0800X
CAA839442083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83944OtherMEDICAL BOARD
MDM67254OtherDIVISION OF DRUG CONTROL
MDD68063OtherBOARD OF PHYSICIANS
CODR-49828OtherLICENSE
MDD68063OtherBOARD OF PHYSICIANS
CODR-49828OtherLICENSE
MDD68063OtherBOARD OF PHYSICIANS
MDM67254OtherDIVISION OF DRUG CONTROL