Basic Information
| Provider Information | |||||||||
| NPI: | 1528222064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOFTIS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 SAWYER DR | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813036560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702593110 | ||||||||
| FaxNumber: | 9702596605 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 SAWYER DR | ||||||||
| Address2: | |||||||||
| City: | DURANGO | ||||||||
| State: | CO | ||||||||
| PostalCode: | 813036560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702593110 | ||||||||
| FaxNumber: | 9702596605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2008 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 48624 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | FL1918171 | 01 | CO | DEA | OTHER | E41160 | 01 | CO | UPIN | OTHER | 27841 | 01 | CO | STATE ID | OTHER |