Healthcare Provider Details

I. General information

NPI: 1104001270
Provider Name (Legal Business Name): PEDRO E COLTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CALLE PAVIA PAVIA MEDICAL PLAZA SUITE 214
SAN JUAN PR
00909-2239
US

IV. Provider business mailing address

611 CALLE PAVIA PAVIA MEDICAL PLAZA SUITE 214
SAN JUAN PR
00909-2239
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-7008
  • Fax:
Mailing address:
  • Phone: 787-726-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number17532
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: