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General NPI Number Information
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NPI Number | 1144640517
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Entity Type | Individual
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Provider Name | MATTHEW DAVID PAUL LEBSACK MD
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Gender | Male
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 296 STAFFORD LN SUITE A
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City | DELTA
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State | CO
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Zip | 81416
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Country | US
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Telephone | 970-874-5777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10100
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City | DELTA
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State | CO
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Zip | 81416-0008
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Country | US
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Telephone | 970-874-7681
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Fax | 970-874-2475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0057475
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License Number State | CO
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