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General NPI Number Information
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NPI Number | 1831402254
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Entity Type | Organization
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Legal Business Name | DAVID J. COLVIN MD LLC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 148 WATERS EDGE DR
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City | SHREVEPORT
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State | LA
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Zip | 71106-7774
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Country | US
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Telephone | 318-797-1687
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Fax |
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Provider Business Mailing Address
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Address Line | 148 WATERS EDGE DR
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City | SHREVEPORT
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State | LA
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Zip | 71106-7774
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Country | US
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Telephone | 318-797-1687
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID J COLVIN
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Credential | M.D.
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Telephone | 318-797-1687
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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 | 022840
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License Number State | LA
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