Healthcare Provider Details

I. General information

NPI: 1811955131
Provider Name (Legal Business Name): SOUTHWEST HEMATOLOGY ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD SUITE 260
PHOENIX AZ
85028-3091
US

IV. Provider business mailing address

11209 N TATUM BLVD SUITE 275
PHOENIX AZ
85028-3091
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-6800
  • Fax: 602-494-6803
Mailing address:
  • Phone: 602-494-6868
  • Fax: 602-494-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY DORIAN ISAACS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 602-494-6800