Healthcare Provider Details

I. General information

NPI: 1982689659
Provider Name (Legal Business Name): COLON AND RECTAL SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 NE 47TH ST STE 102
FT LAUDERDALE FL
33308-7708
US

IV. Provider business mailing address

1960 NE 47TH ST STE 102
FT LAUDERDALE FL
33308-7708
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-4553
  • Fax: 954-771-2372
Mailing address:
  • Phone: 954-772-4553
  • Fax: 954-771-2372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME31566
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME31566
License Number StateFL

VIII. Authorized Official

Name: THOMAS J LESCHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 954-772-4553