Provider Demographics
NPI:1578563813
Name:COLON LIVER GASTRO CONSULTANTS PLLC
Entity Type:Organization
Organization Name:COLON LIVER GASTRO CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-667-7355
Mailing Address - Street 1:PO BOX 711115
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77271-1115
Mailing Address - Country:US
Mailing Address - Phone:832-667-7355
Mailing Address - Fax:281-565-2009
Practice Address - Street 1:16651 SOUTHWEST FWY
Practice Address - Street 2:SUITE 370
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2345
Practice Address - Country:US
Practice Address - Phone:832-667-7355
Practice Address - Fax:281-565-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168610701Medicaid