Provider Demographics
NPI:1811676737
Name:COLBERT, CAMERON
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:COLBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 S 85TH EAST AVE APT 246
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-3050
Mailing Address - Country:US
Mailing Address - Phone:918-845-9697
Mailing Address - Fax:
Practice Address - Street 1:2414 S 85TH EAST AVE APT 246
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-3050
Practice Address - Country:US
Practice Address - Phone:918-845-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management