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General NPI Number Information
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NPI Number | 1063413482
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Entity Type | Individual
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Provider Name | OMAR ALBERTO COLON GUTIERREZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 2800 W 15TH ST
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City | PLANO
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State | TX
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Zip | 75075-7526
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Country | US
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Telephone | 972-378-6908
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Fax | 972-378-6586
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Provider Business Mailing Address
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Address Line | 7750 NORTH MACARTHUR SUITE 120 338
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City | IRVING
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State | TX
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Zip | 75063-7514
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Country | US
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Telephone | 972-378-6908
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Fax | 972-378-6586
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | L3943
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | L3943
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License Number State | TX
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