Provider Demographics
NPI:1790723492
Name:COLTON, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:COLTON
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 1:35 CASA ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1818
Mailing Address - Country:US
Mailing Address - Phone:805-595-1808
Mailing Address - Fax:805-595-1815
Practice Address - Street 1:35 CASA ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1818
Practice Address - Country:US
Practice Address - Phone:805-595-1808
Practice Address - Fax:805-595-1815
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136432207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB241359OtherMEDICARE ID
MO2602607-001OtherCIGNA
MO0700701OtherUNITED HEALTHCARE
MO31875OtherBLUE CROSS
MOBLC29292OtherBLUE CHOICE
MO23478OtherHEALTHCARE USA
MO20394713Medicaid
MOF65908Medicare UPIN
MO000095081Medicare ID - Type Unspecified