Provider Demographics
NPI:1376500256
Name:COLON, EDWARD ANGEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANGEL
Last Name:COLON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 REGIONAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9719
Mailing Address - Country:US
Mailing Address - Phone:979-532-1700
Mailing Address - Fax:979-532-4584
Practice Address - Street 1:7607 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-6219
Practice Address - Country:US
Practice Address - Phone:281-344-0207
Practice Address - Fax:281-239-0114
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01090443OtherRAILROAD MEDICARE PTAN
TX307544201Medicaid
TX875N29OtherBC/BS #
TX307544201Medicaid
TXTXB157049Medicare PIN
TX80N181Medicare ID - Type Unspecified