Individual
DR. JASON T. LEASEBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12605 E 16TH AVE, AURORA, CO 80045-2545
(720) 848-0000
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
M7362
TX
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
Primary
51419
CO
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
M7362
TX
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
ME95042
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188818201
—
TX
01
—
20045344
RAILROAD MEDICARE
TX
05
—
54752566
—
CO
01
—
8B5614
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/31/2006
Last updated
07/12/2013
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