Provider Demographics
NPI:1194727461
Name:COLVERT, JAMES R III (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:COLVERT
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:615 E OKLAHOMA AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5952
Mailing Address - Country:US
Mailing Address - Phone:580-233-3230
Mailing Address - Fax:580-233-0698
Practice Address - Street 1:615 E OKLAHOMA AVE
Practice Address - Street 2:STE 202
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5952
Practice Address - Country:US
Practice Address - Phone:580-233-3230
Practice Address - Fax:580-233-0698
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-08-26
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Provider Licenses
StateLicense IDTaxonomies
OK21222208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP000052000OtherRAILROAD M/C
OK200015940AMedicaid
OKP000052000OtherRAILROAD M/C
OKH91485Medicare UPIN