Active NPI
Leslie E Fuller, DO
- Anesthesiology Physician
- Glenwood SPGS, CO
National Provider Identifier
1962489229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 32980
- Practice address
- 1906 Blake Ave
Glenwood SPGS, CO 81601-4227 - Phone
- (970) 945-6535
- NPI assigned
- Dec 28, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 32980 | CO | Primary |
Addresses
Primary practice location
1906 Blake Ave
Glenwood SPGS, CO 81601-4227
Mailing address
PO Box 932
Glenwood SPGS, CO 81602-0932
Phone (970) 945-1443
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FU12322 | Other | BLUE CROSS | |
| 01329804 | 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
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32980 | CO | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metro Denver Anesthesia PC | Anesthesiology | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192406400000",
"number": "1962489229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 932",
"city": "GLENWOOD SPGS",
"state": "CO",
"postal_code": "816020932",
"telephone_number": "970-945-1443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1906 BLAKE AVE",
"city": "GLENWOOD SPGS",
"state": "CO",
"postal_code": "816014227",
"telephone_number": "970-945-6535"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "LESLIE",
"middle_name": "E",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-28",
"last_updated": "2007-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "CO",
"license": "32980",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "FU12322",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01329804",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glenwood SPGS, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.