Provider Demographics
NPI:1821058199
Name:COLON-GOMEZ, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:COLON-GOMEZ
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 1:609 AVE TITO CASTRO
Mailing Address - Street 2:SUITE 102 PMB 365
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2232
Mailing Address - Country:US
Mailing Address - Phone:787-843-3661
Mailing Address - Fax:787-843-3691
Practice Address - Street 1:EDIF PARRA 2225 PONCE BYPASS
Practice Address - Street 2:SUITE 807-808
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1322
Practice Address - Country:US
Practice Address - Phone:787-812-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10176207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
83214Medicare ID - Type Unspecified