MEDICARE: WALDO JESUS SANTIAGO COLBERG 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD.44741	AL

General Provider Information

NPI Number	:	1134746944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALDO JESUS SANTIAGO COLBERG MD

Provider Business Mailing Address
First Line	:	2570 VILLAGE PROFESSIONAL DR
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-2380
Country	:	US
Telephone Number	:	334-528-7270
Fax Number	:	334-528-7271

Provider Business Practice Location Address
First Line	:	2570 VILLAGE PROFESSIONAL DR
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-2380
Country	:	US
Telephone Number	:	334-528-7270
Fax Number	:	334-528-7271

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/03/2026

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