Provider Demographics
NPI:1225356330
Name:HILL, COLIN G (PA)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:G
Last Name:HILL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1715 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-2938
Mailing Address - Country:US
Mailing Address - Phone:580-548-1777
Mailing Address - Fax:580-254-5899
Practice Address - Street 1:1715 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-2938
Practice Address - Country:US
Practice Address - Phone:580-548-1777
Practice Address - Fax:580-254-5899
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06826363AM0700X
OK1181363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical