Provider Demographics
NPI:1538145289
Name:ABRAHAMSON, LARA (MD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:ABRAHAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3702 AUTOMATION WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5737
Mailing Address - Country:US
Mailing Address - Phone:970-224-1670
Mailing Address - Fax:970-495-6218
Practice Address - Street 1:1113 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5591
Practice Address - Country:US
Practice Address - Phone:970-225-0040
Practice Address - Fax:970-221-5206
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO41086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26677211Medicaid
CO26677211Medicaid
CO512648Medicare PIN