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General NPI Number Information
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NPI Number | 1649466517
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Entity Type | Organization
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Legal Business Name | COLO PROCTOLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 1213 HERMANN DR STE 530
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City | HOUSTON
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State | TX
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Zip | 77004-7011
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Country | US
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Telephone | 713-523-2121
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Fax | 713-523-2151
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Provider Business Mailing Address
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Address Line | 1213 HERMANN DR STE 530
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City | HOUSTON
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State | TX
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Zip | 77004-7011
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Country | US
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Telephone | 713-523-2121
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Fax | 713-523-2151
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCUS MICHAEL AQUINO
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Credential | MD
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Telephone | 713-523-2121
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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 | H4861
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License Number State | TX
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