Provider Demographics
NPI:1114045234
Name:COLON RIVERA, JUAN M (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:COLON RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3103 CALLE SAUSALITO
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-8994
Mailing Address - Country:US
Mailing Address - Phone:787-806-2020
Mailing Address - Fax:787-832-1257
Practice Address - Street 1:410 AVE HOSTOS
Practice Address - Street 2:MAYAGUEZ MEDICAL CENTER
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1560
Practice Address - Country:US
Practice Address - Phone:787-806-2020
Practice Address - Fax:787-832-1257
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4507208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25420Medicare ID - Type Unspecified