Provider Demographics
NPI:1952385502
Name:BUSBY, LESLIE THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:THOMAS
Last Name:BUSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7951 E MAPLEWOOD AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111
Mailing Address - Country:US
Mailing Address - Phone:303-930-7800
Mailing Address - Fax:303-930-7860
Practice Address - Street 1:4715 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1385
Practice Address - Country:US
Practice Address - Phone:303-385-2000
Practice Address - Fax:303-444-1839
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO40330207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84672331Medicaid
COC459818Medicare PIN
G36958Medicare UPIN