Provider Demographics
NPI:1144291618
Name:DEEN, LESLEY THOMAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:LESLEY
Middle Name:THOMAS
Last Name:DEEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:DEEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5881 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2910
Mailing Address - Country:US
Mailing Address - Phone:970-313-2700
Mailing Address - Fax:970-313-2727
Practice Address - Street 1:5881 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2910
Practice Address - Country:US
Practice Address - Phone:970-313-2700
Practice Address - Fax:970-313-2727
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92433341Medicaid
COP00944863OtherMEDICARE RAILROAD CARRIER PTAN
COC455268Medicare PIN
COCOA103886Medicare PIN
COS90607Medicare UPIN