Healthcare Provider Details

I. General information

NPI: 1063097137
Provider Name (Legal Business Name): MONARCH DERMATOLOGY & SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 MOUNTAIN LION DR
LOVELAND CO
80537-8817
US

IV. Provider business mailing address

PO BOX 731
LOVELAND CO
80539-0731
US

V. Phone/Fax

Practice location:
  • Phone: 970-800-9330
  • Fax: 720-927-4301
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-342-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMMON LARSEN
Title or Position: CO-OWNER
Credential:
Phone: 970-667-3116