Provider Demographics
NPI:1740236207
Name:SOUTH TEXAS COMPREHENSIVE CANCER CENTERS PLLC
Entity Type:Organization
Organization Name:SOUTH TEXAS COMPREHENSIVE CANCER CENTERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:AYMAN
Authorized Official - Last Name:GHRAOWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-885-0390
Mailing Address - Street 1:PO BOX 5407
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78465-5407
Mailing Address - Country:US
Mailing Address - Phone:361-885-0390
Mailing Address - Fax:361-904-0178
Practice Address - Street 1:1205 S 19TH ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1527
Practice Address - Country:US
Practice Address - Phone:361-885-0390
Practice Address - Fax:361-904-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6958207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053303255OtherNPI
TX1477545655OtherNPI
TX1942201439OtherNPI