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General NPI Number Information
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NPI Number | 1013967371
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Entity Type | Individual
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Provider Name | ANTONIO E COLLAZO MD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 990 S PROSPECT ST SUITE 1
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City | MARION
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State | OH
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Zip | 43302-6283
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Country | US
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Telephone | 740-383-8060
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Fax | 740-383-7974
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Provider Business Mailing Address
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Address Line | # L-3652
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City | COLUMBUS
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State | OH
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Zip | 43260-6052
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Country | US
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Telephone | 740-383-7927
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Fax | 740-383-7942
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35061525C
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35.061525
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License Number State | OH
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