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General NPI Number Information
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NPI Number | 1912113523
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Entity Type | Organization
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Legal Business Name | COLON AND RECTAL CLINIC OF FORT LAUDERDALE PA
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 350 N PINE ISLAND RD SUITE 300
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City | PLANTATION
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State | FL
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Zip | 33324-1849
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Country | US
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Telephone | 954-236-5444
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Fax | 954-236-5422
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Provider Business Mailing Address
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Address Line | PO BOX 15466
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City | PLANTATION
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State | FL
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Zip | 33318-5466
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Country | US
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Telephone | 954-236-5444
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Fax | 954-236-5422
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES PETER LAGO SR.
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Credential | M.D.
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Telephone | 954-236-5444
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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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