Provider Demographics
NPI:1255638961
Name:MARY M. COLBURN, M.D., P.A.
Entity type:Organization
Organization Name:MARY M. COLBURN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-683-2220
Mailing Address - Street 1:400 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2917
Mailing Address - Country:US
Mailing Address - Phone:561-683-2220
Mailing Address - Fax:
Practice Address - Street 1:400 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2917
Practice Address - Country:US
Practice Address - Phone:561-683-2220
Practice Address - Fax:561-683-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071775174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty