Provider Demographics
NPI:1073692380
Name:COLBERT, RAND LEE (MD)
Entity Type:Individual
Prefix:
First Name:RAND
Middle Name:LEE
Last Name:COLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W 1325 N
Mailing Address - Street 2:#250
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7794
Mailing Address - Country:US
Mailing Address - Phone:435-586-6440
Mailing Address - Fax:435-586-6441
Practice Address - Street 1:166 W 1325 N
Practice Address - Street 2:#250
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7794
Practice Address - Country:US
Practice Address - Phone:435-586-6440
Practice Address - Fax:435-586-6441
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47518020207N00000X
NV12215207N00000X
UT64960371205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100512577Medicaid
UT000060219Medicare PIN
NVV104026Medicare PIN