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General NPI Number Information
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NPI Number | 1730997305
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Entity Type | Organization
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Legal Business Name | MISSION COLON & RECTAL SPECIALISTS PLLC
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Dates
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Enumeration Date | 12/27/2024
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 2120 PRAIRIE DR STE 502
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City | PROSPER
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State | TX
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Zip | 75078-3820
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Country | US
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Telephone | 682-559-0671
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Fax |
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Provider Business Mailing Address
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Address Line | 2750 S PRESTON RD STE 116264
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City | CELINA
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State | TX
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Zip | 75009-3885
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Country | US
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Telephone | 682-559-0671
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Fax |
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Authorized Official
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Title or Position | PLLC
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Name | ANTHONIA ADEWOLE
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Credential | MD
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Telephone | 682-559-0671
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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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