Provider Demographics
NPI:1699782862
Name:RIVERA COLON, JOSE J (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:J
Last Name:RIVERA COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-0727
Mailing Address - Country:US
Mailing Address - Phone:787-857-3999
Mailing Address - Fax:787-857-4287
Practice Address - Street 1:156 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1621
Practice Address - Country:US
Practice Address - Phone:787-857-3999
Practice Address - Fax:787-857-4287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8814208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80024Medicare ID - Type Unspecified
PRD34253Medicare UPIN