=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891742227
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWIN COLON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 02/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8819 RIVER CROSSING BLVD
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-834-8833
-----------------------------------------------------
Fax | 727-834-8842
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 99
-----------------------------------------------------
City | DADE CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33526-0099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-567-4117
-----------------------------------------------------
Fax | 352-567-4122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | ME0056685
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------