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General NPI Number Information
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NPI Number | 1104357714
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Entity Type | Individual
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Provider Name | BENJAMIN JACOB COLBURN MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2017
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 10100 SE SUNNYSIDE RD
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City | CLACKAMAS
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State | OR
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Zip | 97015-8970
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Country | US
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Telephone | 503-494-8211
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Fax |
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Provider Business Mailing Address
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Address Line | 500 NE MULTNOMAH ST STE 100
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City | PORTLAND
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State | OR
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Zip | 97232-2031
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Country | US
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Telephone | 503-494-8211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD191309
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61204134
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License Number State | WA
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