Basic Information
| Provider Information | |||||||||
| NPI: | 1063515484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLBY | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 1ST ST SE | ||||||||
| Address2: | |||||||||
| City: | BELMOND | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504211201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414443500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 403 1ST ST SE | ||||||||
| Address2: | |||||||||
| City: | BELMOND | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504211201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414443500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 02/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01801 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4173294 | 05 | IA | MEDICAID | 5173294 | 05 | IA | MEDICAID |