Provider Demographics
NPI:1982622510
Name:COLLACO, CHRISTOPHER R (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:COLLACO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3914 GRAMERCY ST STE A
Mailing Address - Street 2:SUITE G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1107
Mailing Address - Country:US
Mailing Address - Phone:713-888-0881
Mailing Address - Fax:713-888-0891
Practice Address - Street 1:3914 GRAMERCY ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1160
Practice Address - Country:US
Practice Address - Phone:713-888-0881
Practice Address - Fax:713-888-0891
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL3266207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BV940OtherBCBS
TX0075959OtherBLUE LINK
TX151929002Medicaid
TX0075959OtherBLUE LINK
TX8F9095Medicare PIN