Provider Demographics
NPI:1861405508
Name:THE COLON AND RECTAL CLINIC OF FT LAUDERDALE PA
Entity type:Organization
Organization Name:THE COLON AND RECTAL CLINIC OF FT LAUDERDALE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT FOR THE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LAGO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:954-236-5444
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-236-5444
Mailing Address - Fax:954-236-5422
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-236-5444
Practice Address - Fax:954-236-5422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty