Healthcare Provider Details

I. General information

NPI: 1487883203
Provider Name (Legal Business Name): SANDRA PLYBON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA SLAMKOVA PLYBON MD

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 VERMONT DR UNIT 207
FORT COLLINS CO
80525-5755
US

IV. Provider business mailing address

1327 EAGLE DR
LOVELAND CO
80537-8059
US

V. Phone/Fax

Practice location:
  • Phone: 970-235-1001
  • Fax:
Mailing address:
  • Phone: 970-619-6450
  • Fax: 970-619-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51470
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: