Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | DR.0056330 | CO |
N | 2080P0204X | Pediatric Emergency Doctor | DR.0056330 | CO |
NPI | 1235471715 |
---|---|
Provider Name | Matthew Leroue |
First Address | Aurora, CO 80045-2570 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 22/09/2021 |