Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 10441 | PR |
NPI | 1003933417 |
---|---|
Provider Name | Kermit Richiez Colon |
First Address | Hato Rey, PR 00917-5022 |
Second Address | Hato Rey, PR 00917-5022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 22/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G40374 | (02) | PR |