Provider Demographics
NPI:1831160050
Name:LECOQ, WILLIAM EAVES (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EAVES
Last Name:LECOQ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4500 W. 38TH AVE.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2005
Mailing Address - Country:US
Mailing Address - Phone:303-420-1297
Mailing Address - Fax:303-420-2953
Practice Address - Street 1:4500 W. 38TH AVE.
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2005
Practice Address - Country:US
Practice Address - Phone:303-420-1297
Practice Address - Fax:303-420-2953
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805625Medicare UPIN