Healthcare Provider Details

I. General information

NPI: 1528357662
Provider Name (Legal Business Name): LACEY LAGRONE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE STE 2200
LOVELAND CO
80538
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE NMOB STE 2200
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7250
  • Fax: 970-203-7256
Mailing address:
  • Phone: 970-203-7250
  • Fax: 970-203-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0062998
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: