Individual
COLT ALLEN CANSLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1130 N BALDWIN AVE, MARION, IN 46952-2536
(765) 660-7480
(765) 382-4495
Mailing address
330 N WABASH AVE STE G-20, MARION, IN 46952-2605
(765) 660-7616
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
99062293A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001216651
ANTHEM
IN
05
—
300016910
—
IN
Enumeration date
06/02/2014
Last updated
10/20/2020
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