MEDICARE: DR. CARLOS JAVIER COLLADO-RIVERA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	ME167510	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063093763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS JAVIER COLLADO-RIVERA MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-2052
Fax Number	:	239-343-5348

Provider Business Practice Location Address
First Line	:	6150 MEDICAL PARK LOOP
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4537
Country	:	US
Telephone Number	:	239-722-3600
Fax Number	:	239-772-3995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	07/18/2025

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Directions to “ DR. CARLOS JAVIER COLLADO-RIVERA MD” Practice Location

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