Provider Demographics
NPI:1477633212
Name:MCCOLGAN, STEPHEN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:MCCOLGAN
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:POB 15562
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-925-8892
Mailing Address - Fax:562-866-5978
Practice Address - Street 1:9604 E ARTESIA #200
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706
Practice Address - Country:US
Practice Address - Phone:562-925-8892
Practice Address - Fax:562-866-5978
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50724208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G50724OMedicaid
E02701Medicare UPIN
CA00G50724OMedicaid