Provider Demographics
NPI:1154326395
Name:COLON-PEREZ, BENEDICTO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICTO
Middle Name:
Last Name:COLON-PEREZ
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 789
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0789
Mailing Address - Country:US
Mailing Address - Phone:787-622-0700
Mailing Address - Fax:787-622-0705
Practice Address - Street 1:1845 CARR 2
Practice Address - Street 2:STE 602
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7204
Practice Address - Country:US
Practice Address - Phone:787-622-0700
Practice Address - Fax:787-622-0705
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8385208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080635Medicare ID - Type Unspecified
PRC77770Medicare UPIN