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General NPI Number Information
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NPI Number | 1538342654
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Entity Type | Organization
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Legal Business Name | WILLIAM A COLLAZO, M.D., F.A.C.C.
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 1211 N SHARTEL AVE STE 1006
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2433
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Country | US
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Telephone | 405-546-7699
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Fax | 405-546-7795
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Provider Business Mailing Address
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Address Line | 1211 N SHARTEL AVE STE 1006
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2433
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Country | US
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Telephone | 405-546-7699
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Fax | 405-546-7795
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | WILLIAM A COLLAZO
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Credential | M.D.
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Telephone | 405-546-7699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 17633
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License Number State | OK
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