Provider Demographics
NPI:1871982975
Name:STORZ, COLIN (PA-C)
Entity type:Individual
Prefix:MR
First Name:COLIN
Middle Name:
Last Name:STORZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 N BORTHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1218
Mailing Address - Country:US
Mailing Address - Phone:503-846-6352
Mailing Address - Fax:
Practice Address - Street 1:3623 N BORTHWICK AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1218
Practice Address - Country:US
Practice Address - Phone:503-846-6352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR165805363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical