Provider Demographics
NPI:1467479154
Name:LONE STAR CANCER & BLOOD DISORDER, PA
Entity Type:Organization
Organization Name:LONE STAR CANCER & BLOOD DISORDER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BHACHAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-227-6156
Mailing Address - Street 1:PO BOX 781905
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-1905
Mailing Address - Country:US
Mailing Address - Phone:210-227-6156
Mailing Address - Fax:210-527-1446
Practice Address - Street 1:925 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4643
Practice Address - Country:US
Practice Address - Phone:210-227-6156
Practice Address - Fax:210-527-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00269UMedicare ID - Type Unspecified