Provider Demographics
NPI:1710099726
Name:FOUR CORNERS GASTROENTEROLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:FOUR CORNERS GASTROENTEROLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES MD
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-326-5552
Mailing Address - Street 1:940 W PINON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5905
Mailing Address - Country:US
Mailing Address - Phone:505-326-5552
Mailing Address - Fax:505-326-6727
Practice Address - Street 1:940 W PINON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5905
Practice Address - Country:US
Practice Address - Phone:505-326-5552
Practice Address - Fax:505-326-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherFED TAX ID
300521070Medicare PIN