MEDICARE: WILLIAM A COLLAZO M.D., F.A.C.C.

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	207RC0000X	Cardiovascular Disease Physician	17633	OK

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	:	1649290594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM A COLLAZO M.D., F.A.C.C.

Provider Business Mailing Address
First Line	:	1211 N SHARTEL AVE STE 1006
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2433
Country	:	US
Telephone Number	:	405-546-7699
Fax Number	:	405-546-7795

Provider Business Practice Location Address
First Line	:	1211 N SHARTEL AVE STE 1006
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2433
Country	:	US
Telephone Number	:	405-546-7699
Fax Number	:	405-546-7795

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/27/2021

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