Provider Demographics
NPI:1386639748
Name:LIBBY, ARLENE L (MD)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:L
Last Name:LIBBY
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 1:5802 WRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8806
Mailing Address - Country:US
Mailing Address - Phone:970-212-0530
Mailing Address - Fax:
Practice Address - Street 1:5802 WRIGHT DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8806
Practice Address - Country:US
Practice Address - Phone:970-635-4126
Practice Address - Fax:970-203-2509
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8416A207ZP0102X
CO39358207ZP0102X
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07002378Medicaid
NC89131A8Medicaid
COC809814Medicare PIN
CO07002378Medicaid
NC89131A8Medicaid
COC810506Medicare PIN