Healthcare Provider Details

I. General information

NPI: 1033746524
Provider Name (Legal Business Name): TYLER J EDMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 DRY CREEK DR
LONGMONT CO
80503-6405
US

IV. Provider business mailing address

2500 E PROSPECT RD
FORT COLLINS CO
80525-9718
US

V. Phone/Fax

Practice location:
  • Phone: 303-772-1600
  • Fax: 303-772-9317
Mailing address:
  • Phone: 970-493-0112
  • Fax: 970-493-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0077005
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: