Provider Demographics
NPI:1821081811
Name:COLIGADO, ERIC J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:COLIGADO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1545 E SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6422
Mailing Address - Country:US
Mailing Address - Phone:817-442-9300
Mailing Address - Fax:817-796-0763
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:SUITE 406
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:817-318-1414
Practice Address - Fax:817-318-1515
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2015-01-07
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Provider Licenses
StateLicense IDTaxonomies
TXH7599208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361132YN1EMedicare PIN