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General NPI Number Information
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NPI Number | 1013098607
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Entity Type | Organization
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Legal Business Name | EL PASO COLON AND RECTAL CLINIC PA
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 900 CHELSEA ST
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City | EL PASO
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State | TX
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Zip | 79903-4927
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Country | US
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Telephone | 915-544-4042
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Fax | 915-857-7809
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Provider Business Mailing Address
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Address Line | 4849 N MESA ST STE 201
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City | EL PASO
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State | TX
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Zip | 79912-5919
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Country | US
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Telephone | 915-351-6600
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Fax | 915-351-6601
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS CHRISTINE GOMEZ
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Credential |
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Telephone | 915-544-4042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | H9957
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | N6538
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | N6538
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | H9957
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License Number State | TX
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