Individual
LESLIE E FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1906 BLAKE AVE, GLENWOOD SPGS, CO 81601-4227
(970) 945-6535
Mailing address
PO BOX 932, GLENWOOD SPGS, CO 81602-0932
(970) 945-1443
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
32980
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01329804
—
CO
01
—
FU12322
BLUE CROSS
—
Enumeration date
12/28/2005
Last updated
10/15/2007
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