Provider Demographics
NPI:1154064335
Name:SCOTT L FAHRNER, MD, LLC
Entity Type:Organization
Organization Name:SCOTT L FAHRNER, MD, LLC
Other - Org Name:SCOTT L FAHRNER, MD, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPOUSE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FAHRNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-819-4850
Mailing Address - Street 1:2609 EAGLE ROOST PL
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7244
Mailing Address - Country:US
Mailing Address - Phone:970-819-4843
Mailing Address - Fax:
Practice Address - Street 1:3800 GRANT AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8412
Practice Address - Country:US
Practice Address - Phone:970-622-0608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty