Individual
DR. OTIS CHRISTOPHER COLVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 S JACKSON ST STE C07, LOUISVILLE, KY 40202-1675
(502) 852-5875
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35-126232
OH
2085R0202X
Diagnostic Radiology Physician
Primary
44977
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134089
—
OH
05
—
201136370
—
IN
05
—
7100135110
—
KY
05
—
820183
—
AZ
Enumeration date
04/11/2006
Last updated
06/16/2022
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