Provider Demographics
NPI:1801809074
Name:EAST TEXAS RADIATION ONCOLOGY, PA
Entity type:Organization
Organization Name:EAST TEXAS RADIATION ONCOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOLKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-595-5550
Mailing Address - Street 1:PO BOX 840059
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0059
Mailing Address - Country:US
Mailing Address - Phone:903-595-5550
Mailing Address - Fax:
Practice Address - Street 1:721 CLINIC DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2043
Practice Address - Country:US
Practice Address - Phone:903-595-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029AEOtherBCBS GROUP NUMBER
CE8872OtherRR MEDICARE
TX0029AEOtherBCBS GROUP NUMBER