Provider Demographics
NPI:1699817726
Name:CULPEPPER, CHANTAL RAYUNZA (MD)
Entity Type:Individual
Prefix:MS
First Name:CHANTAL
Middle Name:RAYUNZA
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N. BRENTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-637-5970
Mailing Address - Fax:936-637-5971
Practice Address - Street 1:517 N BRENTWOOD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-7124
Practice Address - Country:US
Practice Address - Phone:936-637-5970
Practice Address - Fax:936-637-5971
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00412420OtherTRAVELER'S MEDICARE #
TX186041301Medicaid
TX8U5694OtherBC/BS TX #
TXH73152Medicare UPIN
TX186041301Medicaid