Provider Demographics
NPI:1770813917
Name:SHOLAR, COLLEEN PATRICIA DEVINE (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:PATRICIA DEVINE
Last Name:SHOLAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-962-3267
Mailing Address - Fax:208-962-2313
Practice Address - Street 1:1055 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544
Practice Address - Country:US
Practice Address - Phone:208-476-5777
Practice Address - Fax:208-476-5385
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDO-0780207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine