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NPI Code Detail

MEDICARE: TOMMIE G COLBERT JR.

MEDICARE: TOMMIE G COLBERT JR.
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1467723221
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOMMIE G COLBERT JR.
Provider Business Mailing Address
First Line : 3305 E FOREST PARK DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73121-2225
Country : US
Telephone Number : 405-424-8352
Fax Number :
Provider Business Practice Location Address
First Line : 3305 E FOREST PARK DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73121-2225
Country : US
Telephone Number : 405-424-8352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2012
Last Update Date : 01/25/2012

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Directions to “ TOMMIE G COLBERT JR. ” Practice Location

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