Provider Demographics
NPI:1528357662
Name:LAGRONE, LACEY (MD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:LAGRONE
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 1:2500 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:NMOB STE 2200
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-203-7250
Mailing Address - Fax:970-203-7256
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 2200
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-203-7250
Practice Address - Fax:970-203-7256
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0062998208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program