Leopold, Derek G

Leopold, Derek G is an individual health care provider with primary practice located at 1925 Mountain View Ave , Longmont CO 80501-3128. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Leopold, Derek G can be contacted via phone (303) 776-1234.

Contact Information

Primary practice address
1925 Mountain View Ave Longmont CO 80501-3128
Phone: (303) 776-1234
Fax: (720) 494-3107
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X TL-3704 Colorado
Allopathic & Osteopathic Physicians / Surgery 208600000X TL.0003704 Colorado
Allopathic & Osteopathic Physicians / Surgery 208600000X DR.0055469 Colorado

Profile Details

NPI number 1255645214
LBN Legal business name Leopold, Derek G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2010
Last updated Sep 4th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255645214 NPPES
Colorado MEDICAID 16323017

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