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NPI Code Detail

MEDICARE: DERECK EMANUEL COLON

MEDICARE: DERECK EMANUEL COLON
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
1390200000XStudent in an Organized Health Care Education/Training ProgramPSI46057FL

General Provider Information

NPI Number : 1467383638
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERECK EMANUEL COLON
Provider Business Mailing Address
First Line : 3890 SW 64TH AVE APT 443
Second Line :
City : DAVIE
State : FL
Zip : 33314-2590
Country : US
Telephone Number : 787-539-1489
Fax Number :
Provider Business Practice Location Address
First Line : 3200 S UNIVERSITY DR
Second Line :
City : DAVIE
State : FL
Zip : 33328-2018
Country : US
Telephone Number : 787-539-1489
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ DERECK EMANUEL COLON ” Practice Location

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