Provider Demographics
NPI:1881776201
Name:COLLAZO-NUNEZ, WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:COLLAZO-NUNEZ
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 1:1933 EXETER DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4817
Mailing Address - Country:US
Mailing Address - Phone:520-458-3445
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC, RWBAHC
Practice Address - Street 2:2240 E. WINROW AVE., ATTN: MCXJ-CREDENTIALS
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7079
Practice Address - Country:US
Practice Address - Phone:520-599-1696
Practice Address - Fax:520-533-7099
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08209208000000X
PR008209171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No208000000XAllopathic & Osteopathic PhysiciansPediatrics