Provider Demographics
NPI:1396794046
Name:KIPE, LARRY WAYNE (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:WAYNE
Last Name:KIPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2018
Mailing Address - Country:US
Mailing Address - Phone:970-824-3252
Mailing Address - Fax:
Practice Address - Street 1:600 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2018
Practice Address - Country:US
Practice Address - Phone:970-824-3252
Practice Address - Fax:970-824-8015
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28686173000000X
CODR0028686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080044735OtherRIO GRAND MEDICARE
CO01286863Medicaid
CO39693OtherBC/BS ANTHEM
COD25103Medicare UPIN
CO080044735OtherRIO GRAND MEDICARE