Healthcare Provider Details

I. General information

NPI: 1629609490
Provider Name (Legal Business Name): MONARCH DERMATOLOGY & SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
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: 717-480-2132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: OWNER
Credential: MD
Phone: 717-480-2132