Provider Demographics
NPI:1609282433
Name:PAIR, COLBY REBECCA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COLBY
Middle Name:REBECCA
Last Name:PAIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:COLBY
Other - Middle Name:REBECCA
Other - Last Name:CORDRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:P.O. BOX 7707
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505
Mailing Address - Country:US
Mailing Address - Phone:903-614-5001
Mailing Address - Fax:903-614-5077
Practice Address - Street 1:2604 ST. MICHAEL DR.
Practice Address - Street 2:SUITE 310
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-614-5001
Practice Address - Fax:903-614-5077
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant