Provider Demographics
NPI:1497329262
Name:STEVEN D COLQUHOUN MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STEVEN D COLQUHOUN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:COLQUHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-500-7421
Mailing Address - Street 1:1600 ROSCOMARE RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-2211
Mailing Address - Country:US
Mailing Address - Phone:310-500-7421
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 880W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6155
Practice Address - Country:US
Practice Address - Phone:310-289-1518
Practice Address - Fax:310-289-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty