Basic Information
| Provider Information | |||||||||
| NPI: | 1679567119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLYER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 RALSTON AVE | ||||||||
| Address2: | SUITE 203A | ||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435125311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197836895 | ||||||||
| FaxNumber: | 4197829288 | ||||||||
| Practice Location | |||||||||
| Address1: | 2940 N MCCORD RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436151753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198423000 | ||||||||
| FaxNumber: | 4192919883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 35080843 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 35080843 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2317700 | 05 | OH | MEDICAID |