MEDICARE: LARYSSA R DRAGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	42831	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598982902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARYSSA R DRAGAN MD

Provider Business Mailing Address
First Line	:	1001A E HARMONY RD STE 425
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3354
Country	:	US
Telephone Number	:	970-300-2711
Fax Number	:	970-237-5484

Provider Business Practice Location Address
First Line	:	2014 CARIBOU DR STE 150
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4373
Country	:	US
Telephone Number	:	970-300-2711
Fax Number	:	415-329-1031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	12/03/2018

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