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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