Provider Demographics
NPI:1386673465
Name:COLONY INTERNAL MEDICINE ASSOCIATES, PA
Entity Type:Organization
Organization Name:COLONY INTERNAL MEDICINE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-265-4168
Mailing Address - Street 1:16651 SOUTHWEST FWY STE 330
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2348
Mailing Address - Country:US
Mailing Address - Phone:281-265-4168
Mailing Address - Fax:281-265-1512
Practice Address - Street 1:16651 SOUTHWEST FWY STE 330
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2348
Practice Address - Country:US
Practice Address - Phone:281-265-4168
Practice Address - Fax:281-265-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00987VMedicare PIN
TX00988VMedicare PIN