Healthcare Provider Details

I. General information

NPI: 1194818195
Provider Name (Legal Business Name): MARK P. COLIP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 STOCKYARD RD BLD 1
MISSOULA MT
59808-1503
US

IV. Provider business mailing address

26350 BUTLER CREEK RD
HUSON MT
59846-9522
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8420
  • Fax: 406-541-8430
Mailing address:
  • Phone: 903-561-6526
  • Fax: 214-889-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11029
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: