MEDICARE: DR. MARCELYN ANN LEPIQUE M.D.

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	207VG0400X	Gynecology Physician	DR.0037629	CO
2	207VG0400X	Gynecology Physician	31971	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4801210	OTHER	AZ	CIGNA
2	AZ0756920	OTHER	AZ	BC/BS AZ
3	201171314	OTHER	AZ	AZ FND MED CARE

General Provider Information

NPI Number	:	1114929783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELYN ANN LEPIQUE M.D.

Provider Business Mailing Address
First Line	:	1311A N MILDRED RD
Second Line	:
City	:	CORTEZ
State	:	CO
Zip	:	81321-2231
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311A N MILDRED RD
Second Line	:
City	:	CORTEZ
State	:	CO
Zip	:	81321-2231
Country	:	US
Telephone Number	:	970-564-2662
Fax Number	:	970-564-2658

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	11/19/2024

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