Provider Demographics
NPI:1598982902
Name:DRAGAN, LARYSSA R (MD)
Entity Type:Individual
Prefix:
First Name:LARYSSA
Middle Name:R
Last Name:DRAGAN
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 1:1001A E HARMONY RD STE 425
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3354
Mailing Address - Country:US
Mailing Address - Phone:970-300-2711
Mailing Address - Fax:970-237-5484
Practice Address - Street 1:2014 CARIBOU DR STE 150
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4373
Practice Address - Country:US
Practice Address - Phone:970-300-2711
Practice Address - Fax:415-329-1031
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42831207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27675530Medicaid
COH55269Medicare UPIN
COCOA105512Medicare PIN
CO27675530Medicaid
CO27675530Medicaid