Basic Information
| Provider Information | |||||||||
| NPI: | 1578563813 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLON LIVER GASTRO CONSULTANTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 711115 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772711115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326677355 | ||||||||
| FaxNumber: | 2815652009 | ||||||||
| Practice Location | |||||||||
| Address1: | 16651 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 370 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774792345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326677355 | ||||||||
| FaxNumber: | 2815652009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | GAJULA | ||||||||
| AuthorizedOfficialFirstName: | LEKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8326677355 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | K9274 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.