MEDICARE: DR. ERIC J COLIGADO M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	H7599	TX

General Provider Information

NPI Number	:	1821081811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC J COLIGADO M.D.

Provider Business Mailing Address
First Line	:	1545 E SOUTHLAKE BLVD
Second Line	:	SUITE 100
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-6422
Country	:	US
Telephone Number	:	817-442-9300
Fax Number	:	817-796-0763

Provider Business Practice Location Address
First Line	:	1305 AIRPORT FWY
Second Line	:	SUITE 406
City	:	BEDFORD
State	:	TX
Zip	:	76021-6605
Country	:	US
Telephone Number	:	817-318-1414
Fax Number	:	817-318-1515

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	01/07/2015

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