Provider Demographics
NPI:1700040490
Name:DALLAS ONCOLOGY CONSULTANTS PA
Entity Type:Organization
Organization Name:DALLAS ONCOLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-283-2389
Mailing Address - Street 1:310 E HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-4159
Mailing Address - Country:US
Mailing Address - Phone:972-283-2389
Mailing Address - Fax:972-283-2473
Practice Address - Street 1:2800 E BROAD ST
Practice Address - Street 2:SUITE 212
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6409
Practice Address - Country:US
Practice Address - Phone:682-518-8444
Practice Address - Fax:682-518-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U90UOtherBLUE CROSS BLUE SHIELD
TX190974901Medicaid
TX00U90UOtherBLUE CROSS BLUE SHIELD