Healthcare Provider Details

I. General information

NPI: 1740717685
Provider Name (Legal Business Name): COLBY JAMES BROOKS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

IV. Provider business mailing address

4990 LAKESHORE RD
FORT GRATIOT MI
48059-3539
US

V. Phone/Fax

Practice location:
  • Phone: 269-985-4632
  • Fax:
Mailing address:
  • Phone: 810-531-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101023144
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101023144
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: