Provider Demographics
NPI:1164221925
Name:MAHAR, COLBY DAVID
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:DAVID
Last Name:MAHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14776 TRADEWINDS RD
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:MN
Mailing Address - Zip Code:56511-9618
Mailing Address - Country:US
Mailing Address - Phone:701-261-5415
Mailing Address - Fax:
Practice Address - Street 1:2905 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-5420
Practice Address - Country:US
Practice Address - Phone:605-626-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program