Provider Demographics
NPI:1801871827
Name:COLOMBO, LIBERTO JR (DO)
Entity type:Individual
Prefix:
First Name:LIBERTO
Middle Name:
Last Name:COLOMBO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9063 STARPASS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5472
Mailing Address - Country:US
Mailing Address - Phone:850-623-9654
Mailing Address - Fax:850-623-9702
Practice Address - Street 1:9063 STARPASS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5472
Practice Address - Country:US
Practice Address - Phone:850-529-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS72792083A0100X, 208D00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59168672OtherBSAL
FL57445OtherBSFL
FL57445OtherBSFL
E68369Medicare UPIN