Active NPI
Leon Stor, PA
- Surgical Physician Assistant
- Lakewood, CO
National Provider Identifier
1235462813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA-2907
- Practice address
- 11750 W 2ND PL
Suite 255
Lakewood, CO 80228-1575 - Phone
- (720) 321-8040
- Fax
- (720) 321-8041
- NPI assigned
- Sep 14, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | |||
| Surgical Physician Assistant | 363AS0400X | PA-2907 | CO | Primary |
Addresses
Primary practice location
11750 W 2ND PL
Suite 255
Lakewood, CO 80228-1575
Mailing address
11750 W 2ND PL
Suite 255
Lakewood, CO 80228-1575
Phone (720) 321-8040
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91104530 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-2907 | CO | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397088000000",
"number": "1235462813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11750 W 2ND PL",
"address_2": "SUITE 255",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802281575",
"telephone_number": "720-321-8040",
"fax_number": "720-321-8041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11750 W 2ND PL",
"address_2": "SUITE 255",
"city": "LAKEWOOD",
"state": "CO",
"postal_code": "802281575",
"telephone_number": "720-321-8040",
"fax_number": "720-321-8041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOR",
"first_name": "LEON",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-14",
"last_updated": "2014-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "CO",
"license": "PA-2907",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "91104530",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.