Provider Demographics
NPI:1932190121
Name:FANTE, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:FANTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3900 E MEXICO AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3940
Mailing Address - Country:US
Mailing Address - Phone:303-839-1616
Mailing Address - Fax:303-839-1991
Practice Address - Street 1:3900 E MEXICO AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3940
Practice Address - Country:US
Practice Address - Phone:303-839-1616
Practice Address - Fax:303-839-1991
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2016-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO37140207W00000X, 2082S0099X, 207WX0200X
NE18881207W00000X, 2082S0099X
MA156104207W00000X, 2082S0099X
MI4301067317207W00000X, 2082S0099X
KS04-27845207W00000X, 2082S0099X
WY6502A207W00000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100328370CMedicaid
CO01371400Medicaid
CO01371400Medicaid
COF10269Medicare UPIN
KS100328370CMedicaid
COF10269Medicare UPIN