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General NPI Number Information
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NPI Number | 1255640603
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Entity Type | Organization
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Legal Business Name | EDWIN COLON, MD PA
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 2407 CYPRESS RIDGE BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6312
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Country | US
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Telephone | 813-907-3300
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Fax | 813-907-3111
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Provider Business Mailing Address
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Address Line | PO BOX 99
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City | DADE CITY
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State | FL
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Zip | 33526-0099
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Country | US
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Telephone | 813-929-3609
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Fax | 813-907-3111
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Authorized Official
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Title or Position | BILLING/CREDENTIALING
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Name | MRS. TARA DE LA CRUZ
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Credential |
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Telephone | 813-929-3609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME56685
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License Number State | FL
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