MEDICARE: DR. DAVID W COLON-GOLDEROS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	12516	PR

General Provider Information

NPI Number	:	1114926342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W COLON-GOLDEROS MD

Provider Business Mailing Address
First Line	:	PO BOX 1901
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-1901
Country	:	US
Telephone Number	:	787-657-5496
Fax Number	:	787-657-5343

Provider Business Practice Location Address
First Line	:	CALLE MAIN A23
Second Line	:	ALTURAS DE RIO GRANDE
City	:	RIO GRANDE
State	:	PR
Zip	:	00745-3473
Country	:	US
Telephone Number	:	787-657-5496
Fax Number	:	787-657-5343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	10/03/2011

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