Provider Demographics
NPI:1538680772
Name:ELDER, COLBY ALAN (MD)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:ALAN
Last Name:ELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9411 N OAK TRFY STE LL1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-691-1655
Mailing Address - Fax:
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 520B
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-691-5198
Practice Address - Fax:816-346-7095
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT214426208600000X
390200000X
MO2024016757208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program