Provider Demographics
NPI:1134201338
Name:COLBERT, DENNIS G (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:G
Last Name:COLBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7601 NATURAL BRIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4904
Mailing Address - Country:US
Mailing Address - Phone:314-383-5221
Mailing Address - Fax:314-383-5228
Practice Address - Street 1:7601 NATURAL BRIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4904
Practice Address - Country:US
Practice Address - Phone:314-383-5221
Practice Address - Fax:314-383-5228
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MORH827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203628011Medicaid
MOC36353Medicare UPIN
MO000094365Medicare ID - Type Unspecified