Basic Information
| Provider Information | |||||||||
| NPI: | 1427015320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BULES | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 CYPRESS WOOD LN | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814163082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709013738 | ||||||||
| FaxNumber: | 9708741631 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 MEEKER ST | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708745777 | ||||||||
| FaxNumber: | 9708741631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36301 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01363019 | 05 | CO | MEDICAID |