MEDICARE: COLO PROCTOLOGY ASSOCIATES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	H4861	TX

General Provider Information

NPI Number	:	1649466517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLO PROCTOLOGY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	1213 HERMANN DR
Second Line	:	STE 530
City	:	HOUSTON
State	:	TX
Zip	:	77004-7011
Country	:	US
Telephone Number	:	713-523-2121
Fax Number	:	713-523-2151

Provider Business Practice Location Address
First Line	:	1213 HERMANN DR
Second Line	:	STE 530
City	:	HOUSTON
State	:	TX
Zip	:	77004-7011
Country	:	US
Telephone Number	:	713-523-2121
Fax Number	:	713-523-2151

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARCUS MICHAEL AQUINO
Credential	:	MD
Telephone Number	:	713-523-2121

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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