MEDICARE: MARK E COLBY PA

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
1	363A00000X	Physician Assistant	10000170A	IN

General Provider Information

NPI Number	:	1447366414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK E COLBY PA

Provider Business Mailing Address
First Line	:	3702 NEW VISION DR BLDG B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1703
Country	:	US
Telephone Number	:	260-266-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 E 7TH ST STE 103
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-2533
Country	:	US
Telephone Number	:	260-927-1982
Fax Number	:	260-927-8380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	01/31/2020

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Directions to “ MARK E COLBY PA” Practice Location

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