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General NPI Number Information
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NPI Number | 1144479007
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Entity Type | Organization
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Legal Business Name | NORTH MIAMI COLORECTAL SURGERY
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 777 E 25TH ST SUITE409
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City | HIALEAH
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State | FL
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Zip | 33013-3825
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Country | US
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Telephone | 305-696-0001
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Fax | 305-696-0007
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Provider Business Mailing Address
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Address Line | 777 E 25TH ST SUITE409
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City | HIALEAH
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State | FL
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Zip | 33013-3825
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Country | US
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Telephone | 305-696-0001
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Fax | 305-696-0007
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ROGER K PONS
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Credential | MD
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Telephone | 305-696-0001
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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