Healthcare Provider Details

I. General information

NPI: 1093109167
Provider Name (Legal Business Name): COLBERT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 HILLCROFT ST # 0
HOUSTON TX
77081-1002
US

IV. Provider business mailing address

6121 HILLCROFT ST STE 0
HOUSTON TX
77081-1002
US

V. Phone/Fax

Practice location:
  • Phone: 713-541-0064
  • Fax:
Mailing address:
  • Phone: 713-541-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberP1533
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberP1533
License Number StateTX

VIII. Authorized Official

Name: CHRISTLE COLBERT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 713-541-0064