Healthcare Provider Details

I. General information

NPI: 1366415754
Provider Name (Legal Business Name): MISTY J COLVIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 W RIVER RD STE 126
TUCSON AZ
85741-3080
US

IV. Provider business mailing address

6200 N LACHOLLA AVENUE ATTN: INA/SHANNON URGENT CARE
TUCSON AZ
85741
US

V. Phone/Fax

Practice location:
  • Phone: 520-219-6616
  • Fax: 520-742-6187
Mailing address:
  • Phone: 520-631-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30841
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: