Provider Demographics
NPI:1215985627
Name:COLL, PAOLO (MD)
Entity type:Individual
Prefix:
First Name:PAOLO
Middle Name:
Last Name:COLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:16620 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-276-1285
Practice Address - Fax:954-602-5048
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME119675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021770800Medicaid
NC5902283Medicaid
NC7662785OtherAETNA
NC183688OtherMEDCOST
NC807596OtherPARTNERS MEDICARE
NC807596OtherPARTNERS MEDICARE
NC2048989Medicare ID - Type Unspecified