Organization
FRONT RANGE DERMATOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE BLUM (PRACTICE MANAGER)
(970) 673-1155
Entity
Organization
Contact information
Practice address
235 W FLETCHER ST, HAXTUN, CO 80731-2737
(970) 673-1155
(970) 673-4747
Mailing address
PO BOX 69, TIMNATH, CO 80547-0069
(970) 301-0130
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528067683
NPI
CO
Enumeration date
12/11/2020
Last updated
12/11/2020
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