Provider Demographics
NPI:1275560328
Name:COLON, JOSE EFRAIN (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:EFRAIN
Last Name:COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE KENNEDY BO. MAMEYAL
Mailing Address - Street 2:92-A
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-632-2742
Mailing Address - Fax:
Practice Address - Street 1:AVE. LUIS MUNOS RIVERA
Practice Address - Street 2:59
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-915-6895
Practice Address - Fax:787-915-6895
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR11383208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR02983Medicare UPIN