Provider Demographics
NPI:1205842747
Name:RIO BRAVO CANCER & BLOOD, P.A.
Entity Type:Organization
Organization Name:RIO BRAVO CANCER & BLOOD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-775-5800
Mailing Address - Street 1:PO BOX 1315
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78841-1315
Mailing Address - Country:US
Mailing Address - Phone:830-775-8000
Mailing Address - Fax:
Practice Address - Street 1:1301 AVENUE G
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3627
Practice Address - Country:US
Practice Address - Phone:830-775-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC5372OtherRAILROAD MEDICARE GROUP #
TX00522WOtherMEDICARE
TX1651671 (01)Medicaid
TX49LWOtherBC/BS GROUP NUMBER
TX1651671 (01)Medicaid