Provider Demographics
NPI:1609859073
Name:COLWELL, BRYAN D (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:COLWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6565 FRANCE AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2137
Mailing Address - Country:US
Mailing Address - Phone:952-920-2200
Mailing Address - Fax:952-920-0866
Practice Address - Street 1:6565 FRANCE AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2137
Practice Address - Country:US
Practice Address - Phone:952-920-2200
Practice Address - Fax:952-920-0866
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2016-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN24764207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN579560500Medicaid
MN579560500Medicaid
MN579560500Medicaid