Provider Demographics
NPI:1891139317
Name:PCR ONCOLOGY, INC.
Entity Type:Organization
Organization Name:PCR ONCOLOGY, INC.
Other - Org Name:PCR ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PALCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-474-9143
Mailing Address - Street 1:584 CAMINO MERCADO
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1816
Mailing Address - Country:US
Mailing Address - Phone:805-474-9143
Mailing Address - Fax:805-474-9569
Practice Address - Street 1:584 CAMINO MERCADO
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1816
Practice Address - Country:US
Practice Address - Phone:805-474-9143
Practice Address - Fax:805-474-9569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60994207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G609941Medicaid
CA110116966OtherRAILROAD MEDICARE
CA00G609940OtherBLUE SHIELD
CA110116966OtherRAILROAD MEDICARE