MEDICARE: DR. RAPHAEL ALEXIS COLON-HERNANDEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	11479	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730382870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAPHAEL ALEXIS COLON-HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	9231 N 29TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-4805
Country	:	US
Telephone Number	:	504-810-3110
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 CALLE ELMA
Second Line	:	CAPARRA HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00920-4703
Country	:	US
Telephone Number	:	504-810-3110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	05/10/2011

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