MEDICARE: MS. CHANTAL RAYUNZA CULPEPPER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M5114	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00412420	OTHER	TX	TRAVELER'S MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8U5694	OTHER	TX	BC/BS TX #

General Provider Information

NPI Number	:	1699817726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANTAL RAYUNZA CULPEPPER MD

Provider Business Mailing Address
First Line	:	517 N. BRENTWOOD DRIVE
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75904
Country	:	US
Telephone Number	:	936-637-5970
Fax Number	:	936-637-5971

Provider Business Practice Location Address
First Line	:	517 N BRENTWOOD
Second Line	:
City	:	LUFKIN
State	:	TX
Zip	:	75904-7124
Country	:	US
Telephone Number	:	936-637-5970
Fax Number	:	936-637-5971

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	06/04/2012

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