MEDICARE: WILLIAM EAVES LECOQ PA

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	363A00000X	Physician Assistant	1511	CO

General Provider Information

NPI Number	:	1831160050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM EAVES LECOQ PA

Provider Business Mailing Address
First Line	:	4500 W. 38TH AVE.
Second Line	:	SUITE 220
City	:	DENVER
State	:	CO
Zip	:	80212-2005
Country	:	US
Telephone Number	:	303-420-1297
Fax Number	:	303-420-2953

Provider Business Practice Location Address
First Line	:	4500 W. 38TH AVE.
Second Line	:	SUITE 220
City	:	DENVER
State	:	CO
Zip	:	80212-2005
Country	:	US
Telephone Number	:	303-420-1297
Fax Number	:	303-420-2953

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	08/30/2010

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Directions to “ WILLIAM EAVES LECOQ PA” Practice Location

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