Provider Demographics
NPI:1801859251
Name:LEAGUE, ANNE LYON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:LYON
Last Name:LEAGUE
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 1:27 BROADMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3613
Mailing Address - Country:US
Mailing Address - Phone:719-527-0751
Mailing Address - Fax:
Practice Address - Street 1:EACH 1650 COCHRANE CR
Practice Address - Street 2:
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-7155
Practice Address - Fax:719-526-7852
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO348702084P0800X
CAA614402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01348705Medicaid
CO01348705Medicaid
G34518Medicare UPIN