Healthcare Provider Details

I. General information

NPI: 1023010592
Provider Name (Legal Business Name): DAVID JUSTON COLVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E COUNTY HIGHWAY B
SHELL LAKE WI
54871-4425
US

IV. Provider business mailing address

PO BOX 5687
SHREVEPORT LA
71135-5687
US

V. Phone/Fax

Practice location:
  • Phone: 337-991-9276
  • Fax:
Mailing address:
  • Phone: 318-797-6661
  • Fax: 318-795-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-50271
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-18377
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84338-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.152204
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL022840
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036167418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: