Provider Demographics
NPI:1437379021
Name:COLBERT, JAY (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:COLBERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21862 AL HWY 59
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-6711
Mailing Address - Country:US
Mailing Address - Phone:251-424-1160
Mailing Address - Fax:251-424-1161
Practice Address - Street 1:21862 AL HWY 59
Practice Address - Street 2:SUITE B
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-6711
Practice Address - Country:US
Practice Address - Phone:251-424-1160
Practice Address - Fax:251-424-1161
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117984207Q00000X
ALDO1433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL132466OtherHEALTH ALLIANCE
IL036117984OtherIL STATE DO LICENSE #
IL799828OtherHEALTHLINK
IL036117984OtherIL STATE DO LICENSE #