Provider Demographics
NPI:1881806644
Name:DISHLER, JON GORDON (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:GORDON
Last Name:DISHLER
Suffix:
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 1:8400 E PRENTICE AVE
Mailing Address - Street 2:#1200
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2912
Mailing Address - Country:US
Mailing Address - Phone:303-793-3000
Mailing Address - Fax:
Practice Address - Street 1:8400 E PRENTICE AVE
Practice Address - Street 2:#1200
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2912
Practice Address - Country:US
Practice Address - Phone:303-793-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22208207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology