Provider Demographics
NPI:1619472040
Name:MCCOLLOSTER, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MCCOLLOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 WOOLDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2402
Mailing Address - Country:US
Mailing Address - Phone:361-994-8979
Mailing Address - Fax:361-994-8966
Practice Address - Street 1:5846 WOOLDRIDGE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2402
Practice Address - Country:US
Practice Address - Phone:361-994-8979
Practice Address - Fax:361-994-8966
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT3821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine