Provider Demographics
NPI:1770736324
Name:RADIATION ONCOLOGISTS OF CENTRAL ARIZONA
Entity type:Organization
Organization Name:RADIATION ONCOLOGISTS OF CENTRAL ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT/COMMITTEE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRESL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:602-441-3845
Mailing Address - Street 1:4611 E. SHEA BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4254
Mailing Address - Country:US
Mailing Address - Phone:602-441-3845
Mailing Address - Fax:602-464-9769
Practice Address - Street 1:4611 E. SHEA BLVD
Practice Address - Street 2:STE 120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4245
Practice Address - Country:US
Practice Address - Phone:602-441-3845
Practice Address - Fax:602-464-9769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391486Medicaid
AZZ126789Medicare PIN