Individual
ANTONIO E COLLAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
990 S PROSPECT ST, SUITE 1, MARION, OH 43302-6283
(740) 383-8060
(740) 383-7974
Mailing address
# L-3652, COLUMBUS, OH 43260-6052
(740) 383-7927
(740) 383-7942
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
35.061525
OH
207Y00000X
Otolaryngology Physician
35061525C
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000118451
ANTHEM
OH
01
—
040005658
TRAVELERS MEDICARE
—
01
—
0695991
PALMETTO MEDICARE
—
05
—
0827458
—
OH
01
—
1000031
UHC
—
01
—
311098079
PPO NEXT
—
01
—
311098079041
CIGNA
—
01
—
353077
SUBMITTER NO.
—
01
—
647955
AETNA
—
Enumeration date
05/10/2006
Last updated
03/21/2022
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