Healthcare Provider Details

I. General information

NPI: 1669436952
Provider Name (Legal Business Name): KELIEGH SUZANNE CULPEPPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7485 E TANQUE VERDE RD
TUCSON AZ
85715-3477
US

IV. Provider business mailing address

7485 E TANQUE VERDE RD
TUCSON AZ
85715-3477
US

V. Phone/Fax

Practice location:
  • Phone: 520-320-7681
  • Fax:
Mailing address:
  • Phone: 520-320-7681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number37485
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number217360
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number12960
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number11649
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number6291615
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number045886
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: