Healthcare Provider Details

I. General information

NPI: 1225828163
Provider Name (Legal Business Name): FRONT RANGE SKINCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14789 W 87TH PKWY
ARVADA CO
80005-1338
US

IV. Provider business mailing address

14789 W 87TH PKWY
ARVADA CO
80005-1338
US

V. Phone/Fax

Practice location:
  • Phone: 720-797-9184
  • Fax: 720-797-9186
Mailing address:
  • Phone: 720-797-9184
  • Fax: 720-797-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WAYNE JOSEPH OVERMAN II
Title or Position: OWNER/DOCTOR OF MEDICINE
Credential: MD
Phone: 970-673-7033