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General NPI Number Information
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NPI Number | 1972587467
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Entity Type | Individual
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Provider Name | GUSTAVO A COLMENARES MD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 10545 BLAIR RD SUITE 1200
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City | MINT HILL
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State | NC
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Zip | 28227-2800
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Country | US
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Telephone | 704-863-9600
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Fax | 704-863-9601
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Provider Business Mailing Address
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Address Line | PO BOX 602478
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City | CHARLOTTE
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State | NC
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Zip | 28260-2478
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Country | US
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Telephone | 704-863-9600
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Fax | 704-863-9601
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0056015
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31295
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2008-01450
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DR.0056015
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License Number State | CO
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