MEDICARE: DR. PEDRO GERARDO 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
1	122300000X	Dentist	1889	PR

General Provider Information

NPI Number	:	1487696381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO GERARDO COLON

Provider Business Mailing Address
First Line	:	201 CALLE GAUTIER BENITEZ
Second Line	:	CONSOLIDATED MEDICAL PLAZA, SUITE 202
City	:	CAGUAS
State	:	PR
Zip	:	00725-5527
Country	:	US
Telephone Number	:	787-743-2128
Fax Number	:	787-743-2128

Provider Business Practice Location Address
First Line	:	201 CALLE GAUTIER BENITEZ
Second Line	:	CONSOLIDATED MEDICAL PLAZA, SUITE 202
City	:	CAGUAS
State	:	PR
Zip	:	00725-5527
Country	:	US
Telephone Number	:	787-743-2128
Fax Number	:	787-743-2128

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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