Provider Demographics
NPI:1568825784
Name:COLBERT, ADAM GRANT (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GRANT
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 1:1200 N EL DORADO PL STE D420
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4637
Mailing Address - Country:US
Mailing Address - Phone:520-442-3422
Mailing Address - Fax:
Practice Address - Street 1:1200 N EL DORADO PL STE D420
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4637
Practice Address - Country:US
Practice Address - Phone:520-442-3422
Practice Address - Fax:520-300-7388
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ603052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program