Provider Demographics
NPI:1811987878
Name:COLON, PASTOR (MD)
Entity type:Individual
Prefix:
First Name:PASTOR
Middle Name:
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 1:46 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:DELLWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1417
Mailing Address - Country:US
Mailing Address - Phone:651-426-4053
Mailing Address - Fax:
Practice Address - Street 1:2960 WINNETKA AVE N
Practice Address - Street 2:SUITE 208
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55427-2853
Practice Address - Country:US
Practice Address - Phone:763-512-1090
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN228302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
02985COOtherBCBS
034966OtherBC VA
0820001OtherPRE 1
0820001OtherPEAK
109040OtherU CARE
02985COOtherBLUE PLUS
1520186OtherMEDCA
1520186OtherADVAN
02985COOtherBC MI
30228600OtherWMA
02985COOtherEPNI
HP13076OtherHP
02985COOtherB L
0820001OtherP1CHP
1521086OtherUHIC
1521086OtherUHIC
0820001OtherPRE 1