Provider Demographics
NPI:1952387441
Name:COLWELL, CHARLES M (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:COLWELL
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 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2175
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:212 E CENTRAL
Practice Address - Street 2:SUITE 140
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6289
Practice Address - Country:US
Practice Address - Phone:509-465-1300
Practice Address - Fax:509-465-1313
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA30476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1090216Medicaid
WAC97669Medicare UPIN
WA1090216Medicaid