Individual
LEON STOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
11750 W 2ND PL, SUITE 255, LAKEWOOD, CO 80228-1575
(720) 321-8040
(720) 321-8041
Mailing address
11750 W 2ND PL, SUITE 255, LAKEWOOD, CO 80228-1575
(720) 321-8040
(720) 321-8041
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA-2907
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91104530
—
CO
Enumeration date
09/14/2009
Last updated
04/10/2014
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