Individual
JOHN R DYGERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
218 E CHEYENNE MOUNTAIN BLVD, COLORADO SPRINGS, CO 80906-3720
(719) 465-1579
(719) 280-6111
Mailing address
218 E CHEYENNE MOUNTAIN BLVD, COLORADO SPRINGS, CO 80906-3720
(719) 465-1579
(719) 280-6111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0535852
KS
207Q00000X
Family Medicine Physician
Primary
DR.0058786
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0058786
COLORADO STATE LICENSE
CO
01
—
05-35852
KANSAS STATE LICENSE
KS
05
—
200879270A
—
KS
Enumeration date
06/17/2009
Last updated
09/01/2021
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