1811987878 NPI number — PASTOR COLON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811987878 NPI number — PASTOR COLON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

COLON

Provider First Name:

PASTOR

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1811987878

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

46 EVERGREEN RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

DELLWOOD

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55110-1417

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

651-426-4053

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2960 WINNETKA AVE N

Provider Second Line Business Practice Location Address:

SUITE 208

Provider Business Practice Location Address City Name:

CRYSTAL

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55427-2853

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

763-512-1090

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/21/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2084P0800X , with the licence number:  22830 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 02985CO . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 034966 . This is a "BC VA" identifier . This identifiers is of the category "OTHER".
• Identifier: 0820001 . This is a "PRE 1" identifier . This identifiers is of the category "OTHER".
• Identifier: 0820001 . This is a "PEAK" identifier . This identifiers is of the category "OTHER".
• Identifier: 109040 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 02985CO . This is a "BLUE PLUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1520186 . This is a "MEDCA" identifier . This identifiers is of the category "OTHER".
• Identifier: 1520186 . This is a "ADVAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 02985CO . This is a "BC MI" identifier . This identifiers is of the category "OTHER".
• Identifier: 30228600 . This is a "WMA" identifier . This identifiers is of the category "OTHER".
• Identifier: 02985CO . This is a "EPNI" identifier . This identifiers is of the category "OTHER".
• Identifier: HP13076 . This is a "HP" identifier . This identifiers is of the category "OTHER".
• Identifier: 02985CO . This is a "B L" identifier . This identifiers is of the category "OTHER".
• Identifier: 0820001 . This is a "P1CHP" identifier . This identifiers is of the category "OTHER".
• Identifier: 1521086 . This is a "UHIC" identifier . This identifiers is of the category "OTHER".