Healthcare Provider Details

I. General information

NPI: 1790767119
Provider Name (Legal Business Name): DOUGLAS COLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 06/15/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 ANDREWS HWY STE 103
MIDLAND TX
79703-4815
US

IV. Provider business mailing address

4214 ANDREWS HWY STE 240
MIDLAND TX
79703-4817
US

V. Phone/Fax

Practice location:
  • Phone: 432-221-1301
  • Fax: 432-221-1307
Mailing address:
  • Phone: 432-686-6600
  • Fax: 432-682-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number223913
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR7968
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: