Organization
COLON AND RECTAL CLINIC OF FORT LAUDERDALE PA
Active
Organization
COLON AND RECTAL CLINIC OF FORT LAUDERDALE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES PETER LAGO SR. M.D. (PRESIDENT)
(954) 236-5444
Entity
Organization
Contact information
Practice address
350 N PINE ISLAND RD, SUITE 300, PLANTATION, FL 33324-1849
(954) 236-5444
(954) 236-5422
Mailing address
PO BOX 15466, PLANTATION, FL 33318-5466
(954) 236-5444
(954) 236-5422
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1380688
UNITED HEALTHCARE
FL
01
—
3423310
AETNA HMO
FL
01
—
7149530
AETNA PPO
FL
01
—
P00068580
MEDICARE RAILROAD
FL
Enumeration date
05/14/2007
Last updated
06/17/2010
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