Healthcare Provider Details

I. General information

NPI: 1518700251
Provider Name (Legal Business Name): LUKE COLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR.
COLUMBIA MO
65212
US

IV. Provider business mailing address

5 HOSPITAL DR # DC029.10
COLUMBIA MO
65212-5276
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8091
  • Fax:
Mailing address:
  • Phone: 573-884-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2024021408
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: