Provider Demographics
NPI:1528220951
Name:CLINICAL ONCOLOGY AND HEMATOLOGY
Entity Type:Organization
Organization Name:CLINICAL ONCOLOGY AND HEMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:CPR
Authorized Official - Phone:770-916-9171
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C-850
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:770-916-9171
Mailing Address - Fax:972-566-7796
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C-850
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:770-916-9171
Practice Address - Fax:972-566-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157308101Medicaid
TX157308101Medicaid
TX00W013Medicare PIN