Provider Demographics
NPI:1982799227
Name:MCCOLGIN, ANN ZERELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:ZERELLA
Last Name:MCCOLGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:THERESE
Other - Last Name:ZERELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6422 E SPEEDWAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1148
Mailing Address - Country:US
Mailing Address - Phone:520-325-9400
Mailing Address - Fax:520-325-8965
Practice Address - Street 1:6422 E SPEEDWAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1148
Practice Address - Country:US
Practice Address - Phone:520-325-9400
Practice Address - Fax:520-325-8965
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30882207W00000X
MA156915207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75776Medicaid
AZZ78587Medicare ID - Type Unspecified
AZ75776Medicaid