Healthcare Provider Details

I. General information

NPI: 1659366797
Provider Name (Legal Business Name): MANUEL J COLON-MENDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MANUEL J COLON MD

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 MOSS PARK RD STE 218
ORLANDO FL
32832-6087
US

IV. Provider business mailing address

1714 PENRITH LOOP
ORLANDO FL
32824-4250
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-5600
  • Fax:
Mailing address:
  • Phone: 787-617-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number127869
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number127869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: