Provider Demographics
NPI:1972594141
Name:COLON, GREGORY L (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8711 VILLAGE DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5418
Mailing Address - Country:US
Mailing Address - Phone:512-754-7700
Mailing Address - Fax:512-754-0012
Practice Address - Street 1:2108 HUNTER RD
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5155
Practice Address - Country:US
Practice Address - Phone:512-754-7700
Practice Address - Fax:512-754-0012
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2017-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ5731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038242608Medicaid
TX038242608Medicaid
TX534506YKRCMedicare PIN
G02673Medicare UPIN
TX038242603Medicaid
805389Medicare ID - Type Unspecified