Provider Demographics
NPI:1386600013
Name:COLON VELEZ, JORGE GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:GABRIEL
Last Name:COLON VELEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 365026
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5026
Mailing Address - Country:US
Mailing Address - Phone:787-722-9416
Mailing Address - Fax:787-723-7945
Practice Address - Street 1:150 AVE. DE DIEGO
Practice Address - Street 2:SUITE 607
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-722-9416
Practice Address - Fax:787-723-7945
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR7797207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77681Medicare UPIN