Provider Demographics
NPI:1942451075
Name:CANCER CARE NETWORK OF SOUTH TEXAS PA
Entity Type:Organization
Organization Name:CANCER CARE NETWORK OF SOUTH TEXAS PA
Other - Org Name:FRED M. MASSEY, M.D. P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-545-6972
Mailing Address - Street 1:7922 EWING HALSELL
Mailing Address - Street 2:STE. 220
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3724
Mailing Address - Country:US
Mailing Address - Phone:210-614-9548
Mailing Address - Fax:210-616-0275
Practice Address - Street 1:7922 EWING HALSELL
Practice Address - Street 2:STE. 220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3724
Practice Address - Country:US
Practice Address - Phone:210-614-9548
Practice Address - Fax:210-616-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U40QOtherBCBS OF TX
TX109514302Medicaid
TX109514302Medicaid
TXCI4583Medicare PIN
TXCN2558Medicare PIN
TXX05189Medicare UPIN