Provider Demographics
NPI:1285776500
Name:COLON GAZTAMBIDE, JOSE MANUEL SR (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:MANUEL
Last Name:COLON GAZTAMBIDE
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:COMERCIO STREET #106
Mailing Address - Street 2:COMERCIO STREET #106
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:797-837-8912
Mailing Address - Fax:787-260-3512
Practice Address - Street 1:COMERCIO STREET #106
Practice Address - Street 2:COMERCIO STREET #106
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:797-837-8912
Practice Address - Fax:787-260-3512
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-02-28
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Provider Licenses
StateLicense IDTaxonomies
PR8769208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E43976Medicare UPIN
PR81659Medicare ID - Type Unspecified