Individual
LARRY WAYNE KIPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 RUSSELL ST, CRAIG, CO 81625-2018
(970) 824-3252
(970) 824-8015
Mailing address
600 RUSSELL ST, CRAIG, CO 81625-2018
(970) 824-3252
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
28686
CO
207Q00000X
Family Medicine Physician
Primary
DR0028686
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01286863
—
CO
01
—
080044735
RIO GRAND MEDICARE
CO
01
—
39693
BC/BS ANTHEM
CO
Enumeration date
05/09/2006
Last updated
03/20/2024
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