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General NPI Number Information
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NPI Number | 1700205374
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Entity Type | Individual
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Provider Name | JOHN BENJAMIN COLBY MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 250 BON AIR RD
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City | GREENBRAE
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State | CA
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Zip | 94904-1702
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Country | US
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Telephone | 415-925-7301
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Fax |
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Provider Business Mailing Address
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Address Line | 500 REDWOOD BLVD STE 300
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City | NOVATO
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State | CA
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Zip | 94947-6921
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Country | US
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Telephone | 415-884-3415
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | A139185
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License Number State | CA
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