Individual
DR. PHILIP B DATTILO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 E HARMONY RD, STE 100, FORT COLLINS, CO 80528-3400
(970) 221-1000
(970) 297-6844
Mailing address
2121 E HARMONY RD, STE 100, FORT COLLINS, CO 80528-3400
(970) 221-1000
(970) 297-6844
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DR.0047426
CO
207RC0000X
Cardiovascular Disease Physician
47426
CO
207RI0011X
Interventional Cardiology Physician
10035A
WY
207RI0011X
Interventional Cardiology Physician
28429
NE
207RI0011X
Interventional Cardiology Physician
Primary
DR.0047426
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245452994
—
WY
05
—
81987064
—
CO
01
—
P01479130
RAILROAD
CO
Enumeration date
05/03/2007
Last updated
12/01/2016
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