Provider Demographics
NPI:1689652851
Name:COLBURN, ALBERT P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:P
Last Name:COLBURN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:505-532-8900
Mailing Address - Fax:505-532-8974
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:505-532-8900
Practice Address - Fax:505-532-8974
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-PA003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR01443Medicare UPIN
NM000R63736Medicare ID - Type Unspecified
NMPA850031Medicare ID - Type Unspecified