Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | M7362 | TX |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 51419 | CO |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M7362 | TX |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME95042 | FL |
NPI | 1184639577 |
---|---|
Provider Name | Dr. Jason T. Leaseburg |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-2545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 12/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188818201 | (05) | TX |
20045344 | RAILROAD MEDICARE (01) | TX |
54752566 | (05) | CO |
8B5614 | BLUE CROSS BLUE SHIELD (01) | TX |
8J9651 | (02) | TX |