Provider Demographics
NPI:1881677003
Name:LASZLO, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:LASZLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4209
Mailing Address - Country:US
Mailing Address - Phone:970-663-0135
Mailing Address - Fax:970-461-1422
Practice Address - Street 1:608 E HARMONY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3210
Practice Address - Country:US
Practice Address - Phone:970-204-9069
Practice Address - Fax:970-624-3021
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27585207K00000X
NE20303207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275858Medicaid
COLAA1088OtherANTHEM BCBS
WY110248600Medicaid
ID806900600Medicaid
CO01275858Medicaid
NE$$$$$$$$$Medicaid
WY110248600Medicaid
CO01275858Medicaid
ID806900600Medicaid
COCA1088Medicare PIN