Healthcare Provider Details

I. General information

NPI: 1831160050
Provider Name (Legal Business Name): WILLIAM EAVES LECOQ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W. 38TH AVE. SUITE 220
DENVER CO
80212-2005
US

IV. Provider business mailing address

4500 W. 38TH AVE. SUITE 220
DENVER CO
80212-2005
US

V. Phone/Fax

Practice location:
  • Phone: 303-420-1297
  • Fax: 303-420-2953
Mailing address:
  • Phone: 303-420-1297
  • Fax: 303-420-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1511
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: