Healthcare Provider Details

I. General information

NPI: 1982044012
Provider Name (Legal Business Name): AMMON LARSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 ST CLOUD DR STE 110
LOVELAND CO
80538-8960
US

IV. Provider business mailing address

4025 ST CLOUD DR STE 110
LOVELAND CO
80538-8960
US

V. Phone/Fax

Practice location:
  • Phone: 970-667-0304
  • Fax: 970-669-5153
Mailing address:
  • Phone: 970-667-0304
  • Fax: 970-669-5153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0058495
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0058495
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: