Healthcare Provider Details

I. General information

NPI: 1639485352
Provider Name (Legal Business Name): DEBORAH ELOMINA COLON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 09/07/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86TH MEDICAL GROUP UNIT 3215, RAMSTEIN AB
APO AE
09094
US

IV. Provider business mailing address

86TH MEDICAL GROUP UNIT 3215, RAMSTEIN AB
APO AE
09094
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: