Healthcare Provider Details

I. General information

NPI: 1073929592
Provider Name (Legal Business Name): LESLI GROSHONG DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 55TH ST
BOULDER CO
80301-2806
US

IV. Provider business mailing address

2323 55TH ST
BOULDER CO
80301-2806
US

V. Phone/Fax

Practice location:
  • Phone: 303-442-4030
  • Fax: 303-443-8375
Mailing address:
  • Phone: 303-442-4030
  • Fax: 303-443-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5444
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: