Provider Demographics
NPI:1205058864
Name:COLON GONZALEZ, JOSE LUIS (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:COLON GONZALEZ
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:CALLE JOSE DE DIEGO #95
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-3227
Mailing Address - Country:US
Mailing Address - Phone:787-884-9289
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE DE DIEGO #95
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3227
Practice Address - Country:US
Practice Address - Phone:787-884-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16620208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice