Provider Demographics
NPI:1114926342
Name:COLON-GOLDEROS, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:COLON-GOLDEROS
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:PO BOX 1901
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-1901
Mailing Address - Country:US
Mailing Address - Phone:787-657-5496
Mailing Address - Fax:787-657-5343
Practice Address - Street 1:CALLE MAIN A23
Practice Address - Street 2:ALTURAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-3473
Practice Address - Country:US
Practice Address - Phone:787-657-5496
Practice Address - Fax:787-657-5343
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12516208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG79078Medicare UPIN
PR0089798Medicare ID - Type Unspecified