Provider Demographics
NPI:1639208457
Name:COLGAN, JAMES R III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:COLGAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:412 W JOHN ST
Mailing Address - Street 2:#1B
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-8811
Mailing Address - Country:US
Mailing Address - Phone:775-883-1030
Mailing Address - Fax:775-883-4677
Practice Address - Street 1:412 W JOHN ST
Practice Address - Street 2:#1B
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-8811
Practice Address - Country:US
Practice Address - Phone:775-883-1030
Practice Address - Fax:775-883-4677
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV2579208800000X
CAGFE15465208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC9683OtherANTHEM BCBS NEVADA
NV30336Medicare ID - Type UnspecifiedMEDICARE-FALLON
NVWJBJC01Medicare ID - Type UnspecifiedMEDICARE-CARSON CITY
NV30333Medicare ID - Type UnspecifiedMEDICARE-YERINGTON
NV30336Medicare ID - Type UnspecifiedMEDICARE-DAYTON
NVWJBJF01Medicare ID - Type UnspecifiedMEDICARE-STATELINE
NV30330Medicare ID - Type UnspecifiedMEDICARE-HAWTHORNE
NVC95904Medicare UPIN
NVCC9683OtherANTHEM BCBS NEVADA