Provider Demographics
NPI:1750304473
Name:COLVIN, JEFFREY N (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:N
Last Name:COLVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 N.LOOP 289 STE 209
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-0416
Mailing Address - Country:US
Mailing Address - Phone:806-797-4596
Mailing Address - Fax:806-797-6518
Practice Address - Street 1:4642 N LOOP 289 STE 209
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2425
Practice Address - Country:US
Practice Address - Phone:806-797-4596
Practice Address - Fax:806-797-6518
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2313207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89V772Medicare PIN
TXE45813Medicare UPIN
TXPENDINGMedicare PIN