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General NPI Number Information
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NPI Number | 1700931490
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Entity Type | Organization
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Legal Business Name | DFW COLON AND RECTAL SURGERY, PA
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 10840 TEXAS HEALTH TRL 200
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City | FORT WORTH
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State | TX
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Zip | 76244-4897
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Country | US
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Telephone | 817-753-7029
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Fax | 817-753-7039
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Provider Business Mailing Address
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Address Line | 10840 TEXAS HEALTH TRL 200
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City | FORT WORTH
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State | TX
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Zip | 76244-4897
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Country | US
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Telephone | 817-753-7029
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Fax | 817-753-7039
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DONNA S LONG
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Credential |
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Telephone | 817-753-7029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | L6097
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License Number State | TX
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