Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH7828 | FL |
NPI | 1407824220 |
---|---|
Provider Name | Michael Lee Colvin |
First Address | Panama City, FL 32401-3757 |
Second Address | Panama City, FL 32401-3757 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 25/03/2013 |