MEDICARE: DR. COLIN MA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD15274	OR
2	207W00000X	Ophthalmology Physician	MD00028055	WA
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	MD00028055	WA
4	207WX0107X	Retina Specialist (Ophthalmology) Physician	MD15274	OR

General Provider Information

NPI Number	:	1164427308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLIN MA M.D.

Provider Business Mailing Address
First Line	:	2525 NW LOVEJOY ST STE 300
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2864
Country	:	US
Telephone Number	:	503-274-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 NW LOVEJOY ST
Second Line	:	STE 100
City	:	PORTLAND
State	:	OR
Zip	:	97210-2861
Country	:	US
Telephone Number	:	503-274-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	04/02/2021

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Directions to “ DR. COLIN MA M.D.” Practice Location

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