Provider Demographics
NPI:1831234632
Name:CONLON, ROBERT MARION III (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARION
Last Name:CONLON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 LUKE ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4037
Mailing Address - Country:US
Mailing Address - Phone:970-484-8686
Mailing Address - Fax:970-484-1064
Practice Address - Street 1:1032 LUKE ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4037
Practice Address - Country:US
Practice Address - Phone:970-484-8686
Practice Address - Fax:970-484-1064
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15058207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01150580Medicaid
COD22784Medicare UPIN
CO01150580Medicaid