Provider Demographics
NPI:1134513229
Name:GENRICH, COLBY MARK
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:MARK
Last Name:GENRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 RAYNOLDS ST # 51015
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-1613
Mailing Address - Country:US
Mailing Address - Phone:915-215-4479
Mailing Address - Fax:
Practice Address - Street 1:9849 KENWORTHY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4402
Practice Address - Country:US
Practice Address - Phone:915-215-5500
Practice Address - Fax:915-215-8655
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2310207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine