Provider Demographics
NPI:1821048752
Name:COLON, GARY PAUL (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:PAUL
Last Name:COLON
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 1:3200 BAILEY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-8523
Mailing Address - Country:US
Mailing Address - Phone:239-262-1721
Mailing Address - Fax:239-262-1045
Practice Address - Street 1:3200 BAILEY LN STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-8523
Practice Address - Country:US
Practice Address - Phone:239-262-1721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076060207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254797000Medicaid
FL43911OtherBCBS
FL254797000Medicaid
FLE0704ZMedicare ID - Type Unspecified
FL43911OtherBCBS