MEDICARE: DR. CHRISTOPHER R. COLLACO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	L3266	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8BV940	OTHER	TX	BCBS
2	0075959	OTHER	TX	BLUE LINK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982622510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER R. COLLACO M.D.

Provider Business Mailing Address
First Line	:	3914 GRAMERCY ST STE A
Second Line	:	SUITE G
City	:	HOUSTON
State	:	TX
Zip	:	77025-1107
Country	:	US
Telephone Number	:	713-888-0881
Fax Number	:	713-888-0891

Provider Business Practice Location Address
First Line	:	3914 GRAMERCY ST
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77025-1160
Country	:	US
Telephone Number	:	713-888-0881
Fax Number	:	713-888-0891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/26/2016

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