Provider Demographics
NPI:1194818195
Name:COLIP, MARK P (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:COLIP
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26350 BUTLER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HUSON
Mailing Address - State:MT
Mailing Address - Zip Code:59846-9522
Mailing Address - Country:US
Mailing Address - Phone:903-561-6526
Mailing Address - Fax:214-889-5353
Practice Address - Street 1:2825 STOCKYARD RD
Practice Address - Street 2:BLD 1
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1503
Practice Address - Country:US
Practice Address - Phone:406-728-8420
Practice Address - Fax:406-541-8430
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MT11029207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC14646Medicare UPIN