Provider Demographics
NPI:1821178716
Name:COLBY, SARA L (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:L
Last Name:COLBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SAMARITAN DR STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3910
Mailing Address - Country:US
Mailing Address - Phone:408-369-5600
Mailing Address - Fax:408-558-7949
Practice Address - Street 1:2400 SAMARITAN DR STE 203
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3910
Practice Address - Country:US
Practice Address - Phone:408-369-5600
Practice Address - Fax:408-558-7949
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT141253207N00000X
CAG48767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48767OtherMEDICAL LICENSE
CAG48767OtherMEDICAL LICENSE
CAZZZ31186ZMedicare ID - Type UnspecifiedMEDICARE GROUP #