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General NPI Number Information
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NPI Number | 1700288271
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Entity Type | Organization
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Legal Business Name | COLORADO MEDICAL LEGAL CONSULTING LLC
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 14742 E LAKE PL
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City | CENTENNIAL
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State | CO
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Zip | 80016-4712
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Country | US
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Telephone | 307-389-7832
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Fax |
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Provider Business Mailing Address
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Address Line | 14742 E LAKE PL
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City | CENTENNIAL
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State | CO
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Zip | 80016-4712
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Country | US
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Telephone | 307-389-7832
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MARK STRATTON LEA
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Credential | MD
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Telephone | 307-389-7832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 27885
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License Number State | CO
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