Organization
COLON & RECTAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. W. REID GRIMES M.D. (VICE PRESIDENT)
(318) 424-8373
Entity
Organization
Contact information
Practice address
1811 E BERT KOUNS STE 430, SHREVEPORT, LA 71105-5741
(318) 424-8373
(318) 424-6477
Mailing address
1811 E BERT KOUNS STE 430, SHREVEPORT, LA 71105-5741
(318) 424-8373
(318) 424-6477
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071416401
—
TX
05
—
1107913
—
LA
Enumeration date
06/29/2006
Last updated
07/21/2022
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