Healthcare Provider Details

I. General information

NPI: 1477665339
Provider Name (Legal Business Name): JOHN D. COLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SE 24TH ST
GAINESVILLE FL
32641-7516
US

IV. Provider business mailing address

224 SE 24TH ST
GAINESVILLE FL
32641-7516
US

V. Phone/Fax

Practice location:
  • Phone: 352-334-7900
  • Fax:
Mailing address:
  • Phone: 352-334-7900
  • Fax: 352-334-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN 142
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: