Provider Demographics
NPI:1003056425
Name:NORTHWEST ONCOLOGY & HEMATOLOGY, PLLC
Entity Type:Organization
Organization Name:NORTHWEST ONCOLOGY & HEMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:OLSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-879-6034
Mailing Address - Street 1:19636 N 27TH AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4019
Mailing Address - Country:US
Mailing Address - Phone:623-879-6034
Mailing Address - Fax:623-879-8164
Practice Address - Street 1:19636 N 27TH AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4013
Practice Address - Country:US
Practice Address - Phone:623-879-6034
Practice Address - Fax:623-879-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1376207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty