Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 31415 | CO |
NPI | 1013913250 |
---|---|
Provider Name | Dr. Larry D Dillon |
First Address | Colorado Springs, CO 80907 |
Second Address | Colorado Springs, CO 80907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 20/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B12322 | (02) | CO |