Provider Demographics
NPI:1558890038
Name:EVERGREEN HEMATOLOGY ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:EVERGREEN HEMATOLOGY ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-923-3388
Mailing Address - Street 1:200 JOSE FIGUERES AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1599
Mailing Address - Country:US
Mailing Address - Phone:408-923-3388
Mailing Address - Fax:408-923-3355
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 245
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1599
Practice Address - Country:US
Practice Address - Phone:408-923-3388
Practice Address - Fax:408-923-3355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44983207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty