Healthcare Provider Details

I. General information

NPI: 1841557741
Provider Name (Legal Business Name): LINDSEY C BANNON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2100
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE NMOB SUITE 2100
LOVELAND CO
80538
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7153
  • Fax: 970-336-1505
Mailing address:
  • Phone: 970-203-7153
  • Fax: 970-336-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0063786
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01073727A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: