Provider Demographics
NPI:1831632710
Name:ARTISAN MD PLLC
Entity type:Organization
Organization Name:ARTISAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-516-9861
Mailing Address - Street 1:1001 E HARMONY RD UNIT A
Mailing Address - Street 2:SUITE 425
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-8888
Mailing Address - Country:US
Mailing Address - Phone:415-516-9861
Mailing Address - Fax:
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:415-516-9861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27675530Medicaid