Provider Demographics
NPI:1649466517
Name:COLO PROCTOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:COLO PROCTOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-523-2121
Mailing Address - Street 1:1213 HERMANN DR
Mailing Address - Street 2:STE 530
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7011
Mailing Address - Country:US
Mailing Address - Phone:713-523-2121
Mailing Address - Fax:713-523-2151
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:STE 530
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7011
Practice Address - Country:US
Practice Address - Phone:713-523-2121
Practice Address - Fax:713-523-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4861208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00W450Medicare PIN