Provider Demographics
NPI:1427024470
Name:COLON-POLANCO, JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:COLON-POLANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-1426
Mailing Address - Country:US
Mailing Address - Phone:903-465-6043
Mailing Address - Fax:903-463-4496
Practice Address - Street 1:2402 W MORTON ST
Practice Address - Street 2:STE 146
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1476
Practice Address - Country:US
Practice Address - Phone:903-465-6043
Practice Address - Fax:903-463-4496
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5293207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115583002Medicaid
TX85X576OtherBCBS PROV #
OK100220200AMedicaid