Healthcare Provider Details

I. General information

NPI: 1659430189
Provider Name (Legal Business Name): JEFFREY DAVID COLVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S MERCY HOSPITAL 2401 GILLHAM ROAD
KANSAS CITY MO
64108
US

IV. Provider business mailing address

1530 RHODE ISLAND ST
LAWRENCE KS
66044-4270
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3000
  • Fax:
Mailing address:
  • Phone: 785-221-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-31389
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: