Basic Information
| Provider Information | |||||||||
| NPI: | 1891803920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAVARD | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E 18TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802061205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033227789 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1353 PASEO DEL PUEBLO SUR STE D | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875715958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756138090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 37215 | CO | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.