Provider Demographics
NPI:1366647141
Name:COLON, LUIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:R
Last Name:COLON
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 1:86 CAMINO DEL BOSQUE
Mailing Address - Street 2:URB SABANERA
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9460
Mailing Address - Country:US
Mailing Address - Phone:787-739-1268
Mailing Address - Fax:787-714-0224
Practice Address - Street 1:86 CAMINO DEL BOSQUE
Practice Address - Street 2:URB SABANERA
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-9460
Practice Address - Country:US
Practice Address - Phone:787-739-1268
Practice Address - Fax:787-714-0224
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6193174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist