MEDICARE: DR. JOSE ENRIQUE COLON M.D.

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	208000000X	Pediatrics Physician	ME35357	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730182312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ENRIQUE COLON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10744
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33757-8744
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:	727-266-4828

Provider Business Practice Location Address
First Line	:	4683 VAN DYKE RD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-4880
Country	:	US
Telephone Number	:	813-968-7171
Fax Number	:	813-968-7282

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/17/2015

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