Provider Demographics
NPI:1548397573
Name:INSTITUTO DIGESTIVO DE PUERTO RICO, P.S.C.
Entity Type:Organization
Organization Name:INSTITUTO DIGESTIVO DE PUERTO RICO, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLON-VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-747-2530
Mailing Address - Street 1:PO BOX 7947
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7947
Mailing Address - Country:US
Mailing Address - Phone:787-747-2530
Mailing Address - Fax:787-744-6392
Practice Address - Street 1:CONSOLIDATED MALL
Practice Address - Street 2:SUITE C-18
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-747-2530
Practice Address - Fax:787-744-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13117207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFP306AMedicare PIN
PRH05649Medicare UPIN