Basic Information
| Provider Information | |||||||||
| NPI: | 1619916079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LESLIE R CAPIN MD PC | ||||||||
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| OtherOrganizationName: | DERMATOLOGY ASSOCIATES OF COLORADO PC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3464 S WILLOW ST | ||||||||
| Address2: | SUITE 060 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802314531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037552900 | ||||||||
| FaxNumber: | 3037550404 | ||||||||
| Practice Location | |||||||||
| Address1: | 13701 E MISSISSIPPI AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800126141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033403378 | ||||||||
| FaxNumber: | 3033403409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 07/29/2013 | ||||||||
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| AuthorizedOfficialLastName: | CAPIN | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3033403378 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 04011102 | 05 | CO | MEDICAID | AUA3308 | 01 | CO | BLUE SHIELD | OTHER | CJ7354 | 01 | CO | RAILROAD MEDICARE | OTHER |