Provider Demographics
NPI:1316986060
Name:CONN, JOHN MILLER SR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MILLER
Last Name:CONN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2222 N NEVADA AVE
Mailing Address - Street 2:SUITE 5017
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6819
Mailing Address - Country:US
Mailing Address - Phone:719-635-2501
Mailing Address - Fax:719-632-1062
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:SUITE 5017
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6819
Practice Address - Country:US
Practice Address - Phone:719-635-2501
Practice Address - Fax:719-632-1062
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32309208G00000X
CO463812086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00152283OtherMEDICARE RAILROAD
AZAZ0755890OtherBCBS
AZ875049Medicaid
AZAZ0755890OtherBCBS
E62595Medicare UPIN