Provider Demographics
NPI:1275139479
Name:FRONT RANGE DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:FRONT RANGE DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-673-1155
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-0069
Mailing Address - Country:US
Mailing Address - Phone:970-301-0130
Mailing Address - Fax:
Practice Address - Street 1:235 W FLETCHER ST
Practice Address - Street 2:
Practice Address - City:HAXTUN
Practice Address - State:CO
Practice Address - Zip Code:80731-2737
Practice Address - Country:US
Practice Address - Phone:970-673-1155
Practice Address - Fax:970-673-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1528067683OtherNPI