Healthcare Provider Details

I. General information

NPI: 1366622235
Provider Name (Legal Business Name): LARRY D. DILLON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 E PIKES PEAK AVE SUITE 209
COLORADO SPRINGS CO
80903-3651
US

IV. Provider business mailing address

559 E PIKES PEAK AVE SUITE 209
COLORADO SPRINGS CO
80903-3651
US

V. Phone/Fax

Practice location:
  • Phone: 719-473-7400
  • Fax: 719-473-7408
Mailing address:
  • Phone: 719-473-7400
  • Fax: 719-473-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number31415
License Number StateCO

VIII. Authorized Official

Name: DR. LARRY D DILLON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 719-473-7400