Provider Demographics
NPI:1578598637
Name:COLT, ROSS (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:COLT
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 1:1706 DESCANSO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2514
Mailing Address - Country:US
Mailing Address - Phone:253-968-1335
Mailing Address - Fax:253-968-2608
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-1335
Practice Address - Fax:253-968-2608
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC155729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine