Provider Demographics
NPI:1871652438
Name:COLBERG, JANSEN (MD)
Entity Type:Individual
Prefix:
First Name:JANSEN
Middle Name:
Last Name:COLBERG
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 909
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0909
Mailing Address - Country:US
Mailing Address - Phone:787-834-9745
Mailing Address - Fax:787-834-9725
Practice Address - Street 1:EDF. DRS. COLBERG
Practice Address - Street 2:CARR. 100 KM 5.2 BARRIO MIRADERO #2424
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-0909
Practice Address - Country:US
Practice Address - Phone:787-834-9745
Practice Address - Fax:787-834-9725
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12870207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH32614Medicare UPIN
PR0020343Medicare ID - Type Unspecified