Provider Demographics
NPI:1013922533
Name:COLVER, KEVIN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAY
Last Name:COLVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:J
Other - Last Name:COLVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1045 S 1700 W
Mailing Address - Street 2:#1113
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5518
Mailing Address - Country:US
Mailing Address - Phone:801-380-8979
Mailing Address - Fax:
Practice Address - Street 1:1500 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6504
Practice Address - Country:US
Practice Address - Phone:352-671-2254
Practice Address - Fax:352-671-2291
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1744531205207R00000X
FLME 117393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063197Medicare PIN