Provider Demographics
NPI:1114929783
Name:LEPIQUE, MARCELYN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELYN
Middle Name:ANN
Last Name:LEPIQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1311A N MILDRED RD
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1311A N MILDRED RD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2231
Practice Address - Country:US
Practice Address - Phone:970-564-2662
Practice Address - Fax:970-564-2658
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ31971207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ201171314OtherAZ FND MED CARE
AZAZ0756920OtherBC/BS AZ
AZ4801210OtherCIGNA