Provider Demographics
NPI:1609324151
Name:BLISS, COLBY (PA-C)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:BLISS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 N PAIUTE WAY
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1849
Mailing Address - Country:US
Mailing Address - Phone:435-893-0977
Mailing Address - Fax:
Practice Address - Street 1:826 N PAIUTE WAY
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1849
Practice Address - Country:US
Practice Address - Phone:435-893-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6955139-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical