Healthcare Provider Details

I. General information

NPI: 1003887738
Provider Name (Legal Business Name): LEON SAMUEL GREOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 E BRIARWOOD AVE STE 340
CENTENNIAL CO
80112-3913
US

IV. Provider business mailing address

125 RAMPART WAY STE 200
DENVER CO
80230-6429
US

V. Phone/Fax

Practice location:
  • Phone: 303-632-3694
  • Fax: 303-632-3692
Mailing address:
  • Phone: 720-858-7550
  • Fax: 720-858-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberDR.0028923
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: