Basic Information
| Provider Information | |||||||||
| NPI: | 1568062206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONARCH DERMATOLOGY & SURGERY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 731 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805390731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706632742 | ||||||||
| FaxNumber: | 9703422093 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 S 8TH AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807514560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708009330 | ||||||||
| FaxNumber: | 7209274301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2020 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | LARSEN | ||||||||
| AuthorizedOfficialFirstName: | AMMON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/AUTHORIZED REP | ||||||||
| AuthorizedOfficialTelephone: | 9706673116 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.