Healthcare Provider Details

I. General information

NPI: 1437121100
Provider Name (Legal Business Name): KYLE COLVETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N STATE OF FRANKLIN RD CANCER TREATMENT CENTER
JOHNSON CITY TN
37604-6035
US

IV. Provider business mailing address

PO BOX 5099
JOHNSON CITY TN
37602-5099
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-6000
  • Fax: 423-431-6060
Mailing address:
  • Phone: 423-431-6000
  • Fax: 423-431-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD0000027621
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: