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NPI Code Detail

MEDICARE: MARY M. COLBURN, M.D., P.A.

MEDICARE: MARY M. COLBURN, M.D., P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME0071775FL

General Provider Information

NPI Number : 1255638961
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARY M. COLBURN, M.D., P.A.
Provider Business Mailing Address
First Line : 400 EXECUTIVE CENTER DR
Second Line : SUITE 102
City : WEST PALM BEACH
State : FL
Zip : 33401-2917
Country : US
Telephone Number : 561-683-2220
Fax Number :
Provider Business Practice Location Address
First Line : 400 EXECUTIVE CENTER DR
Second Line : SUITE 102
City : WEST PALM BEACH
State : FL
Zip : 33401-2917
Country : US
Telephone Number : 561-683-2220
Fax Number : 561-683-3885
Authorized Official
Title or Position : ONWER/PRESIDENT
Name : DR. MARY M. COLBURN
Credential : M.D.
Telephone Number : 561-683-2220
Provider Enumeration Date : 02/15/2011
Last Update Date : 02/15/2011

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