Provider Demographics
NPI:1295791267
Name:COLON MARTINEZ, JORGE GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:GABRIEL
Last Name:COLON MARTINEZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:150 AVE DE DIEGO
Mailing Address - Street 2:SAN JUAN HEALTH CENTRE SUITE 607
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2300
Mailing Address - Country:US
Mailing Address - Phone:787-722-9416
Mailing Address - Fax:
Practice Address - Street 1:150 AVE DE DIEGO
Practice Address - Street 2:SAN JUAN HEALTH CENTRE SUITE 607
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-722-9416
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR9665207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF99378Medicare UPIN