Provider Demographics
NPI:1235394727
Name:CHRISTOPHER COLLACO MD PHD PA
Entity Type:Organization
Organization Name:CHRISTOPHER COLLACO MD PHD PA
Other - Org Name:ADVANCED ASTHMA & ALLERGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:713-502-7932
Mailing Address - Street 1:4003 BELLAIRE BLVD
Mailing Address - Street 2:G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1160
Mailing Address - Country:US
Mailing Address - Phone:713-502-7932
Mailing Address - Fax:
Practice Address - Street 1:4003 BELLAIRE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1160
Practice Address - Country:US
Practice Address - Phone:281-253-3557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3266207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty