Individual
PASTOR COLON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2960 WINNETKA AVE N, SUITE 208, CRYSTAL, MN 55427-2853
(763) 512-1090
Mailing address
46 EVERGREEN RD, DELLWOOD, MN 55110-1417
(651) 426-4053
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
22830
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02985CO
BCBS
—
01
—
034966
BC VA
—
01
—
0820001
PRE 1
—
01
—
109040
U CARE
—
01
—
1520186
MEDCA
—
01
—
1521086
UHIC
—
01
—
30228600
WMA
—
01
—
HP13076
HP
—
Enumeration date
10/21/2005
Last updated
03/07/2023
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