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General NPI Number Information
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NPI Number | 1144266628
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Entity Type | Organization
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Legal Business Name | DENTON COLON AND RECTAL SURGERY, P.A.
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 1300 FULTON ST SUITE 203
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City | DENTON
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State | TX
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Zip | 76201-2688
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Country | US
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Telephone | 940-383-2424
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Fax | 940-387-5676
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Provider Business Mailing Address
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Address Line | 1300 FULTON ST SUITE 203
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City | DENTON
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State | TX
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Zip | 76201-2688
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Country | US
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Telephone | 940-383-2424
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Fax | 940-387-5676
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARIA A. PROVOST
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Credential | MD
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Telephone | 940-383-2424
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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 | M2618
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License Number State | TX
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