Healthcare Provider Details

I. General information

NPI: 1154513307
Provider Name (Legal Business Name): LESLEY N BEVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 01/28/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE SUITE 470
DENVER CO
80220-3912
US

IV. Provider business mailing address

4900 S MONACO ST SUITE 210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-8499
  • Fax: 303-320-8620
Mailing address:
  • Phone: 303-320-8499
  • Fax: 303-320-8620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125049093
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number47903
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: