Healthcare Provider Details

I. General information

NPI: 1730292228
Provider Name (Legal Business Name): HEMATOLOGY AND ONCOLOGY ASSOCIATES OF ALABAMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GOODYEAR AVE
GADSDEN AL
35903-1156
US

IV. Provider business mailing address

PO BOX 131329
BIRMINGHAM AL
35213-6329
US

V. Phone/Fax

Practice location:
  • Phone: 256-492-0375
  • Fax: 256-492-9811
Mailing address:
  • Phone: 205-271-8541
  • Fax: 205-271-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELQUIS M. CASTILLO
Title or Position: PRESIDENT
Credential: MD
Phone: 205-271-8541