Provider Demographics
NPI:1518120104
Name:MEDICAL ONCOLOGY OF SAN ANTONIO PA
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY OF SAN ANTONIO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUIARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHERRARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-599-0922
Mailing Address - Street 1:PO BOX 2219
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-1219
Mailing Address - Country:US
Mailing Address - Phone:210-599-0922
Mailing Address - Fax:210-967-8586
Practice Address - Street 1:12705 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3257
Practice Address - Country:US
Practice Address - Phone:210-599-0922
Practice Address - Fax:210-967-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty