Coladom Medical Group, P.a.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

N2694 Issued in TX

Legal business name

COLADOM MEDICAL GROUP, P.A.

Practice address

510 Med CT
Suite 107
San Antonio, TX 78258-3482

Phone

(210) 455-0074

Fax

(210) 455-0124

NPI assigned

May 19, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kolawole Ademuyiwa Odulaja, M.D.

Title

Director

Phone

(210) 455-0074

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313712000000",
    "number": "1841519618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 MED CT",
            "address_2": "SUITE 107",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583482",
            "telephone_number": "210-455-0074",
            "fax_number": "210-455-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 MED CT",
            "address_2": "SUITE 107",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583482",
            "telephone_number": "210-455-0074",
            "fax_number": "210-455-0124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLADOM MEDICAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-19",
        "last_updated": "2011-08-19",
        "status": "A",
        "authorized_official_last_name": "ODULAJA",
        "authorized_official_first_name": "KOLAWOLE",
        "authorized_official_middle_name": "ADEMUYIWA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "210-455-0074",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N2694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "217153001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TEXAS",
            "identifier": "0008TN",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Coker, MS, CCC-SLP
• Miranda Coker, MSN, RN
• Jenny Louise Cokerham, FNP
• Zoey Cola
• Geoff Colacino, RN
• Roxanne Colazo, RN
• Jeffrey Adam Colburn, MD
• Rea Anastacio Colby, CRNP
• Cole Vision Corporation
• Dominique Cole-Valenzuela

• Internal Medicine Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.