Provider Demographics
NPI:1801837067
Name:WANG, COLBY LOWEL (MD)
Entity Type:Individual
Prefix:DR
First Name:COLBY
Middle Name:LOWEL
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PREVENTATIVE
Other - Middle Name:
Other - Last Name:PSYCHIATRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:715 KENSINGTON AVE
Mailing Address - Street 2:SUITE 24 B
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5700
Mailing Address - Country:US
Mailing Address - Phone:406-830-3294
Mailing Address - Fax:
Practice Address - Street 1:715 KENSINGTON AVE STE 24B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5700
Practice Address - Country:US
Practice Address - Phone:406-830-3294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT343582084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000095505Medicare ID - Type Unspecified