Provider Demographics
NPI:1811906126
Name:COLVIN, CHARLES PEYTON (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PEYTON
Last Name:COLVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:833 SAINT VINCENTS DR
Mailing Address - Street 2:POB 3 SUITE 402
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1606
Mailing Address - Country:US
Mailing Address - Phone:205-933-9236
Mailing Address - Fax:205-933-9213
Practice Address - Street 1:3686 GRANDVIEW PKWY 530
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3326
Practice Address - Country:US
Practice Address - Phone:205-933-9277
Practice Address - Fax:205-212-3544
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18817207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000024037Medicaid
AL000024037Medicare PIN
ALF80847Medicare UPIN