Healthcare Provider Details

I. General information

NPI: 1568456622
Provider Name (Legal Business Name): DOUGLAS ALLAN LEACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2352 MEADOWS BLVD STE 240B
CASTLE ROCK CO
80109-8406
US

IV. Provider business mailing address

2356 MEADOWS BLVD STE 240B
CASTLE ROCK CO
80109-8410
US

V. Phone/Fax

Practice location:
  • Phone: 303-649-3380
  • Fax:
Mailing address:
  • Phone: 303-795-3110
  • Fax: 303-649-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number61822
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberDR.0071452
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: