Provider Demographics
NPI:1528042462
Name:MARTINEZ COLON, JORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:MARTINEZ 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:PO BOX 10610
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0610
Mailing Address - Country:US
Mailing Address - Phone:787-848-0008
Mailing Address - Fax:787-848-0008
Practice Address - Street 1:86 AVE FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4061
Practice Address - Country:US
Practice Address - Phone:787-848-0008
Practice Address - Fax:787-848-0008
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6218207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE04100Medicare UPIN
PR0026039Medicare ID - Type Unspecified