Provider Demographics
NPI:1174591861
Name:VILLA COLON, JAIME R (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:R
Last Name:VILLA COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2225 PONCE BYPASS
Mailing Address - Street 2:PARRA BUILDING 403
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1320
Mailing Address - Country:US
Mailing Address - Phone:787-259-3391
Mailing Address - Fax:787-259-8474
Practice Address - Street 1:2225 PONCE BYPASS
Practice Address - Street 2:PARRA BUILDING 403
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1320
Practice Address - Country:US
Practice Address - Phone:787-259-3391
Practice Address - Fax:787-259-8474
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8852207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081526Medicare PIN
E10146Medicare UPIN