Provider Demographics
NPI:1720086069
Name:COLON, ANGEL R (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:R
Last Name:COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6470
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6470
Mailing Address - Country:US
Mailing Address - Phone:787-265-3730
Mailing Address - Fax:787-265-3730
Practice Address - Street 1:1065 AVE LOS CORAZONES
Practice Address - Street 2:EDIF MEDICO PROFESIONAL; OFIC 110-111
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-7060
Practice Address - Country:US
Practice Address - Phone:787-265-3730
Practice Address - Fax:787-265-3730
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR103002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082611Medicare ID - Type UnspecifiedPROVIDER NUMBER