Healthcare Provider Details

I. General information

NPI: 1497765812
Provider Name (Legal Business Name): WILLIAM SEAN CONLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 LUKE ST
FORT COLLINS CO
80524-4037
US

IV. Provider business mailing address

1032 LUKE ST
FORT COLLINS CO
80524-4037
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-8686
  • Fax: 970-484-1064
Mailing address:
  • Phone: 970-484-8686
  • Fax: 970-484-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number38718
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number38718
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number38718
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number38718
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: