Provider Demographics
NPI:1982689659
Name:COLON AND RECTAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:COLON AND RECTAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LESCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-772-4553
Mailing Address - Street 1:1960 NE 47TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7708
Mailing Address - Country:US
Mailing Address - Phone:954-772-4553
Mailing Address - Fax:954-771-2372
Practice Address - Street 1:1960 NE 47TH ST
Practice Address - Street 2:STE 102
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7708
Practice Address - Country:US
Practice Address - Phone:954-772-4553
Practice Address - Fax:954-771-2372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31566208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF7517OtherRAILROAD RETIREMENT
FL24917OtherBCBS
FL24917Medicare ID - Type Unspecified