MEDICARE: JEFFREY MICHAEL COLBERT M.D.

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	207X00000X	Orthopaedic Surgery Physician	G46171	CA

General Provider Information

NPI Number	:	1487656286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MICHAEL COLBERT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3129
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90510-3129
Country	:	US
Telephone Number	:	310-792-3914
Fax Number	:	855-898-4055

Provider Business Practice Location Address
First Line	:	4644 LINCOLN BLVD
Second Line	:	SUITE 530
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-6313
Country	:	US
Telephone Number	:	310-421-2111
Fax Number	:	310-822-4104

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/16/2015

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