Provider Demographics
NPI:1871654913
Name:COLOMBO, JOHN M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:COLOMBO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6393 NW 106TH TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3766
Mailing Address - Country:US
Mailing Address - Phone:484-832-7161
Mailing Address - Fax:
Practice Address - Street 1:2990 EXECUTIVE WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6543
Practice Address - Country:US
Practice Address - Phone:954-276-6245
Practice Address - Fax:954-286-1457
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024973E207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001619073Medicaid
PA151182Medicare ID - Type Unspecified
PAC32012Medicare UPIN