Healthcare Provider Details

I. General information

NPI: 1326074774
Provider Name (Legal Business Name): BRUCE W KORNFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BOISE AVE
LOVELAND CO
80538-5016
US

IV. Provider business mailing address

1317 TEAKWOOD DR
FORT COLLINS CO
80525-1959
US

V. Phone/Fax

Practice location:
  • Phone: 970-682-3377
  • Fax: 970-682-3340
Mailing address:
  • Phone: 970-222-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number27691
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number27691
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number27691
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: