Provider Demographics
NPI:1720782022
Name:KOONTZ, COLBY B (MD)
Entity Type:Individual
Prefix:DR
First Name:COLBY
Middle Name:B
Last Name:KOONTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11520 E SKELETON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73736-1208
Mailing Address - Country:US
Mailing Address - Phone:580-231-1555
Mailing Address - Fax:
Practice Address - Street 1:11520 E SKELETON RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:OK
Practice Address - Zip Code:73736-1208
Practice Address - Country:US
Practice Address - Phone:580-231-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program