Provider Demographics
NPI:1083873574
Name:COLON, MODESTO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:MODESTO
Middle Name:JOSE
Last Name:COLON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3131 E CLARENDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7069
Mailing Address - Country:US
Mailing Address - Phone:602-253-9168
Mailing Address - Fax:602-251-3126
Practice Address - Street 1:3131 E CLARENDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7069
Practice Address - Country:US
Practice Address - Phone:602-253-9168
Practice Address - Fax:602-251-3126
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2016-07-25
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Provider Licenses
StateLicense IDTaxonomies
AZ52510208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)