Healthcare Provider Details

I. General information

NPI: 1720086069
Provider Name (Legal Business Name): ANGEL R COLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 AVE LOS CORAZONES EDIF MEDICO PROFESIONAL; OFIC 110-111
MAYAGUEZ PR
00680-7060
US

IV. Provider business mailing address

PO BOX 6470
MAYAGUEZ PR
00681-6470
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-3730
  • Fax: 787-265-3730
Mailing address:
  • Phone: 787-265-3730
  • Fax: 787-265-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10300
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: