Provider Demographics
NPI:1184973786
Name:FRONT RANGE DERMATOLOGY ASSOCIATES
Entity type:Organization
Organization Name:FRONT RANGE DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:Z
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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
Mailing Address - Country:US
Mailing Address - Phone:970-673-1155
Mailing Address - Fax:970-673-4747
Practice Address - Street 1:6801 WEST 20TH
Practice Address - Street 2:SUITE 208
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634
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:2012-08-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49733207ND0900X
207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45021023Medicaid
COCOAAA3047OtherMEDICARE PTAN
COCOAAA3047Medicare UPIN