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General NPI Number Information
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NPI Number | 1699703330
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Entity Type | Organization
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Legal Business Name | COLON & RECTAL ASSOCIATES PC
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1811 E BERT KOUNS STE 430
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City | SHREVEPORT
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State | LA
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Zip | 71105-5741
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Country | US
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Telephone | 318-424-8373
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Fax | 318-424-6477
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Provider Business Mailing Address
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Address Line | 1811 E BERT KOUNS STE 430
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City | SHREVEPORT
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State | LA
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Zip | 71105-5741
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Country | US
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Telephone | 318-424-8373
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Fax | 318-424-6477
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. W. REID GRIMES
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Credential | M.D.
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Telephone | 318-424-8373
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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 | LA
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