Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN15124 | FL |
NPI | 1023028941 |
---|---|
Provider Name | Dr. Walter E. Colon II |
First Address | Tallahassee, FL 32308-5324 |
Second Address | Tallahassee, FL 32308-5324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 26/12/2013 |