=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801208558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR CARLOS COLON, PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2014
-----------------------------------------------------
Last Update Date | 05/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2225 PONCE BY PASS SUITE 807 PARRA MEDICAL PLAZA
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-843-3661
-----------------------------------------------------
Fax | 787-843-3691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2225 PONCE BY PASS SUITE 807 PARRA MEDICAL PLAZA
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-843-3661
-----------------------------------------------------
Fax | 787-843-3691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | CARLOS COLON GOMEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-843-3661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------