Healthcare Provider Details

I. General information

NPI: 1972574218
Provider Name (Legal Business Name): RICARDO LUIS COLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N SEMORAN BLVD
ORLANDO FL
32807-3323
US

IV. Provider business mailing address

431 N SEMORAN BLVD
ORLANDO FL
32807-3323
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-5054
  • Fax: 407-894-7818
Mailing address:
  • Phone: 407-894-5054
  • Fax: 407-894-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberACN1622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: