Healthcare Provider Details

I. General information

NPI: 1679565758
Provider Name (Legal Business Name): DANN CONRAD BYCK III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 BRIARGATE PKWY STE 300
COLORADO SPRINGS CO
80920-3487
US

IV. Provider business mailing address

4105 BRIARGATE PKWY STE 300
COLORADO SPRINGS CO
80920-3487
US

V. Phone/Fax

Practice location:
  • Phone: 719-420-0200
  • Fax: 719-352-0121
Mailing address:
  • Phone: 719-402-0200
  • Fax: 719-352-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number51866291205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberCDR.0002201
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: