Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.061525 | OH |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 35061525C | OH |
NPI | 1013967371 |
---|---|
Provider Name | Antonio E Collazo |
First Address | Columbus, OH 43260-6052 |
Second Address | Marion, OH 43302-6283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 07/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000118451 | ANTHEM (01) | OH |
040005658 | TRAVELERS MEDICARE (01) | |
0695991 | PALMETTO MEDICARE (01) | |
0827458 | (05) | OH |
1000031 | UHC (01) | |
311098079 | PPO NEXT (01) | |
311098079 | TAX ID # (01) | |
311098079041 | CIGNA (01) | |
353077 | SUBMITTER NO. (01) | |
647955 | AETNA (01) | |
E92790 | (02) |