Healthcare Provider Details

I. General information

NPI: 1295940211
Provider Name (Legal Business Name): GORDON LEIGH NELIGH III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 S GAYLORD ST
DENVER CO
80209-4683
US

IV. Provider business mailing address

1017 S GAYLORD ST
DENVER CO
80209-4683
US

V. Phone/Fax

Practice location:
  • Phone: 303-744-3377
  • Fax:
Mailing address:
  • Phone: 303-744-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number28042
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number28042
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28042
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number28042
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: