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NPI Code Detail

MEDICARE: DR. EARL J COLBERT

MEDICARE:  DR. EARL J COLBERT
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry22591NV

General Provider Information

NPI Number : 1982788626
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EARL J COLBERT
Provider Business Mailing Address
First Line : PO BOX 17179
Second Line :
City : IRVINE
State : CA
Zip : 92623-7179
Country : US
Telephone Number : 949-567-3176
Fax Number : 949-567-3185
Provider Business Practice Location Address
First Line : 5527 S RAINBOW BLVD STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-1882
Country : US
Telephone Number : 702-367-4440
Fax Number : 702-365-0723
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/08/2007

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Directions to “ DR. EARL J COLBERT ” Practice Location

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