Healthcare Provider Details

I. General information

NPI: 1083532303
Provider Name (Legal Business Name): MONTROSE DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 COMMERCIAL WAY
MONTROSE CO
81401-5693
US

IV. Provider business mailing address

2730 COMMERCIAL WAY
MONTROSE CO
81401-5693
US

V. Phone/Fax

Practice location:
  • Phone: 970-964-4036
  • Fax:
Mailing address:
  • Phone: 970-964-4036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY PEETERS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 970-964-4036