Provider Demographics
NPI:1912937939
Name:COLIN, WAYNE BRIAN (DMD, MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:BRIAN
Last Name:COLIN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-430-2209
Mailing Address - Fax:606-218-7509
Practice Address - Street 1:911 BYPASS RD BLDG A
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-430-2209
Practice Address - Fax:606-218-7509
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34451204E00000X, 207YX0007X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64345416Medicaid
GACB5773OtherRR MEDICARE GROUP
KY4000501OtherMEDICARE LAB GROUP
GA040016970OtherRR MEDICARE PIN
KY37903705OtherMEDICAID LAB GROUP
KY64345416Medicaid
KY0169Medicare PIN
KY0091281Medicare ID - Type Unspecified