Provider Demographics
NPI:1023189685
Name:NORTHWEST ONCOLOGY CLINIC, PA
Entity Type:Organization
Organization Name:NORTHWEST ONCOLOGY CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-440-8951
Mailing Address - Street 1:810 PEAKWOOD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2909
Mailing Address - Country:US
Mailing Address - Phone:281-440-8951
Mailing Address - Fax:281-440-0280
Practice Address - Street 1:810 PEAKWOOD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2909
Practice Address - Country:US
Practice Address - Phone:281-440-8951
Practice Address - Fax:281-440-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7024207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032318001Medicaid
TX032318001Medicaid
TXB22557Medicare UPIN