Provider Demographics
NPI:1770809535
Name:COLON-PINEIRO, EDGARDO LUIS (MD)
Entity type:Individual
Prefix:
First Name:EDGARDO
Middle Name:LUIS
Last Name:COLON-PINEIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13600 HORIZON BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5810
Mailing Address - Country:US
Mailing Address - Phone:915-267-0028
Mailing Address - Fax:915-267-0029
Practice Address - Street 1:13600 HORIZON BLVD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-5810
Practice Address - Country:US
Practice Address - Phone:915-298-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17866208D00000X
TXQ2986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice