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General NPI Number Information
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NPI Number | 1083716138
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Entity Type | Organization
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Legal Business Name | SOUTHWESTERN COLON & RECTAL SURGERY, PA
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 4007 JAMES CASEY DR STE D150
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City | AUSTIN
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State | TX
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Zip | 78745-3346
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Country | US
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Telephone | 512-447-8911
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Fax | 512-447-8761
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Provider Business Mailing Address
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Address Line | 4007 JAMES CASEY DR STE D150
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City | AUSTIN
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State | TX
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Zip | 78745-3346
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Country | US
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Telephone | 512-447-8911
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICARDO LERMA SOLIS
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Credential | M.D.
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Telephone | 512-447-8911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L1757
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License Number State | TX
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