Provider Demographics
NPI:1952403925
Name:LEA, MARK STRATTON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STRATTON
Last Name:LEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14742 E LAKE PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-4712
Mailing Address - Country:US
Mailing Address - Phone:307-389-7832
Mailing Address - Fax:303-568-9077
Practice Address - Street 1:14742 E LAKE PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-4712
Practice Address - Country:US
Practice Address - Phone:307-389-7832
Practice Address - Fax:303-568-9077
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6351A208600000X
CO27885208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYE46950Medicare UPIN
WY114783800Medicaid
WY310223Medicare ID - Type UnspecifiedGENERAL SURGERY