Provider Demographics
NPI:1184695645
Name:CONNER, GEORGE MARC (DPM)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MARC
Last Name:CONNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 MEDICAL CENTER PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5700
Mailing Address - Country:US
Mailing Address - Phone:719-473-3338
Mailing Address - Fax:
Practice Address - Street 1:1633 MEDICAL CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5700
Practice Address - Country:US
Practice Address - Phone:719-473-3338
Practice Address - Fax:719-327-6379
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD.0000594213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72755718Medicaid
COU85244Medicare UPIN
CO396608Medicare PIN