Provider Demographics
NPI:1700931490
Name:DFW COLON AND RECTAL SURGERY, PA
Entity Type:Organization
Organization Name:DFW COLON AND RECTAL SURGERY, PA
Other - Org Name:AUGUSTINE J. LEE, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-753-7029
Mailing Address - Street 1:10840 TEXAS HEALTH TRL
Mailing Address - Street 2:200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4897
Mailing Address - Country:US
Mailing Address - Phone:817-753-7029
Mailing Address - Fax:817-753-7039
Practice Address - Street 1:10840 TEXAS HEALTH TRL
Practice Address - Street 2:200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4897
Practice Address - Country:US
Practice Address - Phone:817-753-7029
Practice Address - Fax:817-753-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6097208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X501Medicare PIN
TXI12212Medicare UPIN