Provider Demographics
NPI:1447296025
Name:LELAND, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:LELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SUPERIOR DR
Mailing Address - Street 2:STE 225
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8661
Mailing Address - Country:US
Mailing Address - Phone:303-665-2603
Mailing Address - Fax:303-665-2605
Practice Address - Street 1:4740 PEARL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3080
Practice Address - Country:US
Practice Address - Phone:303-449-2730
Practice Address - Fax:303-449-5821
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39667207XX0004X
CODR.0039667207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77922239Medicaid
CO508488Medicare PIN