Individual
DR. COLIN WILFRED DEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4006 JOHNATHAN ST STE B, WATERLOO, IA 50701-9395
(319) 233-1540
Mailing address
PO BOX 2758, WATERLOO, IA 50704-2758
(319) 235-5390
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
6659
NE
207Q00000X
Family Medicine Physician
Primary
DO-05193
IA
Other
Enumeration date
06/29/2011
Last updated
07/05/2022
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