Provider Demographics
NPI:1952411266
Name:COL, ALBERT PROMIS (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:PROMIS
Last Name:COL
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:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-725-3122
Mailing Address - Fax:209-725-3128
Practice Address - Street 1:3385 G ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0964
Practice Address - Country:US
Practice Address - Phone:209-725-3122
Practice Address - Fax:209-725-3128
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG61355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G613550Medicaid
CAE30093Medicare UPIN
CAAM959ZMedicare PIN