Provider Demographics
NPI:1699856757
Name:COLTON, CARL G (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:G
Last Name:COLTON
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 1:2811 TAMIAMI TRL UNIT I
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5135
Mailing Address - Country:US
Mailing Address - Phone:941-246-2700
Mailing Address - Fax:941-246-2701
Practice Address - Street 1:2811 TAMIAMI TRL UNIT I
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5135
Practice Address - Country:US
Practice Address - Phone:941-246-2700
Practice Address - Fax:941-246-2701
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146664207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015133050011Medicaid
PA0015133050012Medicaid
PA648243KKUMedicare ID - Type Unspecified