Individual
LESLIE GINGER FREDERIKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4010 JERRY MURPHY ROAD, PUEBLO, CO 81001-1045
(719) 546-2229
(719) 583-9069
Mailing address
PO BOX 560825, DENVER, CO 80256-0825
(719) 595-7580
(719) 545-0176
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
41018
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11199754
CAQH
CO
05
—
48506311
—
CO
01
—
D009
CHAMPUS
CO
Enumeration date
06/27/2006
Last updated
07/21/2022
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