Healthcare Provider Details

I. General information

NPI: 1255693453
Provider Name (Legal Business Name): GARRET THOMAS LECHTENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E KEN PRATT BLVD STE 205
LONGMONT CO
80504-5311
US

IV. Provider business mailing address

1760 E KEN PRATT BLVD STE 205
LONGMONT CO
80504-5311
US

V. Phone/Fax

Practice location:
  • Phone: 720-718-3930
  • Fax: 720-718-0939
Mailing address:
  • Phone: 720-718-3930
  • Fax: 720-718-0939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number67072
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number62014
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0076300
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: