Individual
DR. COLTON AUSTIN FAZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3030 HARDEN BLVD, LAKELAND, FL 33803-7952
(863) 687-1250
Mailing address
2100 STANTONSBURG RD, GREENVILLE, NC 27834-2818
(252) 744-4757
(252) 847-1985
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME139617
FL
207PS0010X
Sports Medicine (Emergency Medicine) Physician
ME139617
FL
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
ME139617
FL
Other
Enumeration date
05/04/2016
Last updated
02/11/2026
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