Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A103590 | CA |
N | 2080P0203X | Pediatric Critical Care Doctor | 13957 | NV |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD60580688 | WA |
NPI | 1225154628 |
---|---|
Provider Name | Dr. David Alexander Colvin |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-4379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13957 | STATE MEDICAL BOARD (01) | NV |
ASO2532199106 | DEA CERTIFICATE (01) | NV |
FC0808420 | DEA (01) | CA |
FC5497486 | DEA (01) | WA |
MD60580688 | STATE MEDICAL BOARD (01) | WA |