Provider Demographics
NPI:1871541581
Name:COLAH, XERXES R (MD)
Entity type:Individual
Prefix:DR
First Name:XERXES
Middle Name:R
Last Name:COLAH
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 1:915 13TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5067
Mailing Address - Country:US
Mailing Address - Phone:563-243-2511
Mailing Address - Fax:563-243-0817
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:563-243-0817
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24660207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
516008OtherIOWA HEALTH SOLUTIONS
100092OtherHEALTH ALLIANCE
IA20308OtherWELLMARK BC/BS
IA0222851Medicaid
IA0109OtherJOHN DEERE HEALTH
237499OtherMIDLANDS CHOICE
IA20308OtherWELLMARK BC/BS
100092OtherHEALTH ALLIANCE
IAI14010Medicare PIN
200005039Medicare PIN