Provider Demographics
NPI:1154316685
Name:COLON-PAGAN, JUAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:R
Last Name:COLON-PAGAN
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 1:6 DIAMANTE ST
Mailing Address - Street 2:URB. BUCARE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5115
Mailing Address - Country:US
Mailing Address - Phone:787-505-9621
Mailing Address - Fax:787-250-1029
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:STE 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2103
Practice Address - Country:US
Practice Address - Phone:787-764-8787
Practice Address - Fax:787-250-1029
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2172207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24118AMedicare ID - Type Unspecified
C78025Medicare UPIN