Provider Demographics
NPI:1841161767
Name:COLBERT, JOSHUA JOHN
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOHN
Last Name:COLBERT
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 1:10900 MAPLE GRV
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5109
Mailing Address - Country:US
Mailing Address - Phone:918-500-6716
Mailing Address - Fax:
Practice Address - Street 1:10900 MAPLE GRV
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5109
Practice Address - Country:US
Practice Address - Phone:918-500-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist