Organization
LAKE LOVELAND DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN JOHN MOTT MD (OWNER)
(303) 569-7700
Entity
Organization
Contact information
Practice address
1708 BOISE AVE, LOVELAND, CO 80538-4204
(970) 667-3116
(970) 669-0159
Mailing address
PO BOX 7643, LOVELAND, CO 80537-0643
(970) 663-2742
(970) 342-2093
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
CO
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04014833
—
CO
Enumeration date
11/16/2006
Last updated
11/06/2020
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