Individual
MR. OMAR ALBERTO COLON GUTIERREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2800 W 15TH ST, PLANO, TX 75075-7526
(972) 378-6908
(972) 378-6586
Mailing address
7750 NORTH MACARTHUR, SUITE 120 338, IRVING, TX 75063-7514
(972) 378-6908
(972) 378-6586
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
L3943
TX
225400000X
Rehabilitation Practitioner
L3943
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8V3207
BCBS
—
01
—
L3943
LICENSE NUMBER
TX
Enumeration date
08/09/2005
Last updated
03/12/2014
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