Lake Loveland Dermatology PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LAKE LOVELAND DERMATOLOGY PC

Practice address

555 Prospect Ave
Estes Park, CO 80517-6312

Phone

(970) 667-3119

Fax

(970) 669-0159

NPI assigned

Nov 5, 2020

Last updated

Jan 19, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin John MottNPI 1295776201

Title

Owner

Phone

(303) 569-7700

Specialties & licenses 4

Addresses

Tax ID family

Lake Loveland Dermatology PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Lake Loveland Dermatology PC

  • Dermatology Physician
  • Sterling, CO
  • NPI 1437750304
  NPD tax ID
• Lake Loveland Dermatology PC

  • Dermatology Physician
  • Fort Collins, CO
  • NPI 1700487675
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin John Mott, MD

  • MOHS-Micrographic Surgery Physician
  • Loveland, CO
  • NPI 1295776201

  Dermatology

  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1265033138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7643",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805370643",
            "telephone_number": "970-663-2742",
            "fax_number": "970-342-2093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 PROSPECT AVE",
            "city": "ESTES PARK",
            "state": "CO",
            "postal_code": "805176312",
            "telephone_number": "970-667-3119",
            "fax_number": "970-669-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE LOVELAND DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-05",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A",
        "authorized_official_last_name": "MOTT",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-569-7700"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Leslie Keller, LPC
• Kylee Kimball, DPT
• John D Knudtson, MD
• Kristine G. Musick, PH.D., LLC
• Meemee Lahman, LPC,LAC,MFTC,MA
• Christopher Lamar, MA
• Larimer County School District R-3
• Ronald Gregory Legge, PHARMACIST
• Life Rhythms
• Marybeth Lisse

• Dermatology Physician in Estes Park, CO
• Providers in Estes Park, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.