Provider Demographics
NPI:1689659088
Name:COLON PEREZ, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:COLON PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:R
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8340
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0340
Mailing Address - Country:US
Mailing Address - Phone:787-723-2202
Mailing Address - Fax:787-723-1955
Practice Address - Street 1:1420 CALLE AMERICO SALAS
Practice Address - Street 2:STE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2139
Practice Address - Country:US
Practice Address - Phone:787-723-2202
Practice Address - Fax:787-723-1955
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8262208G00000X
PR008262207RC0000X, 207RC0200X, 207RP1001X, 2086S0129X, 2085U0001X, 2086S0102X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
82517Medicare ID - Type Unspecified
C14675Medicare UPIN