Provider Demographics
NPI:1366622235
Name:LARRY D. DILLON, M.D., P.C.
Entity type:Organization
Organization Name:LARRY D. DILLON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-473-7400
Mailing Address - Street 1:559 E PIKES PEAK AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3651
Mailing Address - Country:US
Mailing Address - Phone:719-473-7400
Mailing Address - Fax:719-473-7408
Practice Address - Street 1:559 E PIKES PEAK AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3651
Practice Address - Country:US
Practice Address - Phone:719-473-7400
Practice Address - Fax:719-473-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO314152086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC455898Medicare PIN