Provider Demographics
NPI:1972563203
Name:COLON COLON, JOSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:COLON COLON
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 1:576 AVE CESAR GONZALEZ
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-296-1655
Mailing Address - Fax:787-296-1659
Practice Address - Street 1:576 AVE CESAR GONZALEZ
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-296-1655
Practice Address - Fax:787-296-1659
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89775Medicare ID - Type UnspecifiedPROVIDER NUMBER