Individual
LIBERTO COLOMBO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9063 STARPASS DR, JACKSONVILLE, FL 32256-5472
(850) 529-0040
Mailing address
9063 STARPASS DR, JACKSONVILLE, FL 32256-5472
(850) 623-9654
(850) 623-9702
Taxonomy
Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
OS7279
FL
2083X0100X
Occupational Medicine Physician
Primary
OS7279
FL
208D00000X
General Practice Physician
OS7279
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57445
BSFL
FL
01
—
59168672
BSAL
FL
Enumeration date
12/13/2005
Last updated
11/17/2022
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