Healthcare Provider Details

I. General information

NPI: 1265685218
Provider Name (Legal Business Name): JORGE A COLON MORALES M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE STA JUANITA PLAZA STA JUANITA M71 STA JUANITA
BAYAMON PR
00956-4647
US

IV. Provider business mailing address

PO BOX 1119
BAYAMON PR
00960-1119
US

V. Phone/Fax

Practice location:
  • Phone: 787-412-5328
  • Fax:
Mailing address:
  • Phone: 787-412-5328
  • Fax: 787-993-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number17384
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: