Healthcare Provider Details

I. General information

NPI: 1184689507
Provider Name (Legal Business Name): COLON & RECTAL SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOUMA BLVD SUITE 540
METAIRIE LA
70006-2933
US

IV. Provider business mailing address

4224 HOUMA BLVD SUITE 540
METAIRIE LA
70006-2933
US

V. Phone/Fax

Practice location:
  • Phone: 504-456-5108
  • Fax: 504-456-5109
Mailing address:
  • Phone: 504-456-5108
  • Fax: 504-456-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY F GRIFFIN
Title or Position: PARTNER
Credential: MD
Phone: 504-456-5108