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Individual

COLBY RIP WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
566 RUIN CREEK RD, HENDERSON, NC 27536-2927
(919) 461-0017
Mailing address
1218 MAROON DR, DURHAM, NC 27713-8233
(702) 596-9122

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12596
NC

Other

Enumeration date
06/24/2022
Last updated
09/27/2023
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