Provider Demographics
NPI:1891073011
Name:PALO VERDE HEMATOLOGY ONCOLOGY, LTD
Entity Type:Organization
Organization Name:PALO VERDE HEMATOLOGY ONCOLOGY, LTD
Other - Org Name:PALO VERDE CANCER SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/SHAREHOLDER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAIDER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-978-6255
Mailing Address - Street 1:5601 W EUGIE AVE
Mailing Address - Street 2:#106
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1255
Mailing Address - Country:US
Mailing Address - Phone:602-978-6255
Mailing Address - Fax:602-644-3661
Practice Address - Street 1:9250 W. THOMAS RD.
Practice Address - Street 2:#150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037
Practice Address - Country:US
Practice Address - Phone:602-978-6255
Practice Address - Fax:623-478-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ141061835X0200X
AZ242843336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336S0011XSuppliersPharmacySpecialty PharmacyGroup - Single Specialty
No1835X0200XPharmacy Service ProvidersPharmacistOncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0908090003Medicare NSC