Provider Demographics
NPI:1013174432
Name:OVERDORF, COLLEEN M (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:OVERDORF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17744 FENNEL RD SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9071
Mailing Address - Country:US
Mailing Address - Phone:317-409-0414
Mailing Address - Fax:
Practice Address - Street 1:500 LILLY RD NE STE 201
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5197
Practice Address - Country:US
Practice Address - Phone:360-413-8272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA336144207RP1001X, 207RC0200X
WAOP60631569207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease