Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | ME101315 | FL |
NPI | 1174670020 |
---|---|
Provider Name | Jose Colon |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33912-4437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000127200 | (05) | FL |