Provider Demographics
NPI:1689767550
Name:COLLAZO, GILBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:
Last Name:COLLAZO
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 429
Mailing Address - Street 2:
Mailing Address - City:OSMOND
Mailing Address - State:NE
Mailing Address - Zip Code:68765-0429
Mailing Address - Country:US
Mailing Address - Phone:402-748-3393
Mailing Address - Fax:402-748-6190
Practice Address - Street 1:100 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WAUSA
Practice Address - State:NE
Practice Address - Zip Code:68786-2050
Practice Address - Country:US
Practice Address - Phone:402-586-2244
Practice Address - Fax:402-586-2580
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07417OtherBCBS OF NE
NE1852OtherMIDLANDS CHOICE
NED99538Medicare UPIN
NE260044Medicare PIN