Healthcare Provider Details

I. General information

NPI: 1275521015
Provider Name (Legal Business Name): NORMAN G. MACLEOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 MARKET ST
ALAMOSA CO
81101-2290
US

IV. Provider business mailing address

1020 S. CONWELL STREET
CASPER WY
82601
US

V. Phone/Fax

Practice location:
  • Phone: 719-587-1001
  • Fax:
Mailing address:
  • Phone: 307-265-8300
  • Fax: 307-233-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36534
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: