Provider Demographics
NPI:1497798961
Name:KILBOURN, ROBERT G (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:KILBOURN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1927
Mailing Address - Country:US
Mailing Address - Phone:970-986-3622
Mailing Address - Fax:970-683-5249
Practice Address - Street 1:600 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5711
Practice Address - Country:US
Practice Address - Phone:970-240-7242
Practice Address - Fax:970-240-7793
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9913207RH0003X
CO46571207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00670077OtherRAILROAD MEDICARE
CO81509847Medicaid
TX100448301Medicaid
TX100448301Medicaid
TXD95810Medicare UPIN
CO81509847Medicaid