Doctor Name: | AGUSTIN COLLADO |
NPI Number: | 1700899820 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME0019427 |
Business Practice Address: | 3340 Tamiami Trl Port Charlotte, FL - 339528088 |
Business Phone Number: | 9417645858 |
Business Fax Number: | 9417641657 |
Mailing Address: | 21405 Olean Blvd, Ste#225 PORT CHARLOTTE |
State: | FL |
Postal Code: | 339526877 |
Phone Number: | 9416256806 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | ME0019427 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |