MEDICARE: DR. ROBERTO J 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	207R00000X	Internal Medicine Physician	35081454	OH

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	:	1780674952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO J COLON M.D.

Provider Business Mailing Address
First Line	:	725 UNIVERSITY BLVD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45435-0001
Country	:	US
Telephone Number	:	937-245-7100
Fax Number	:	937-245-7999

Provider Business Practice Location Address
First Line	:	1222 S PATTERSON BLVD
Second Line	:	STE 230
City	:	DAYTON
State	:	OH
Zip	:	45402-2684
Country	:	US
Telephone Number	:	937-223-5350
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	02/13/2013

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