Provider Demographics
NPI:1023011491
Name:TYLER HEMATOLOGY ONCOLOGY, P.A.
Entity Type:Organization
Organization Name:TYLER HEMATOLOGY ONCOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-593-8264
Mailing Address - Street 1:721 CLINIC DR
Mailing Address - Street 2:STE A
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2043
Mailing Address - Country:US
Mailing Address - Phone:903-592-6152
Mailing Address - Fax:903-526-0629
Practice Address - Street 1:721 CLINIC DR
Practice Address - Street 2:STE A
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2043
Practice Address - Country:US
Practice Address - Phone:903-592-6152
Practice Address - Fax:903-526-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106291101Medicaid
TX045835803Medicaid
TX102771601Medicaid
TX130290303Medicaid
TX161891001Medicaid
TX1705592-03Medicaid
TX095058601Medicaid
TX89M833Medicare ID - Type UnspecifiedROBERT DRODER, MD
TX102771601Medicaid
TX045835803Medicaid
TXH29560Medicare UPIN
TX161891001Medicaid
TX359299ZHVSMedicare PIN
TXF71999Medicare UPIN
TX8L22890Medicare PIN
TXE89273Medicare UPIN
TX00A55JMedicare ID - Type UnspecifiedGROUP ID
TX8B9477Medicare ID - Type UnspecifiedJOSEPH MARTINS, MD
TX1705592-03Medicaid
TXG99801Medicare UPIN
TXB42259Medicare UPIN
TX82420NMedicare ID - Type UnspecifiedMICHAEL ASHIGBI, MD
TX8D7633Medicare ID - Type UnspecifiedMAUNG OO, MD
TX130290303Medicaid