Healthcare Provider Details

I. General information

NPI: 1033161757
Provider Name (Legal Business Name): SOUTHWEST ONCOLOGY & HEMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 N 5TH AVENUE SUITE 400
PHOENIX AZ
85013-3899
US

IV. Provider business mailing address

3411 N 5TH AVENUE SUITE 400
PHOENIX AZ
85013-3899
US

V. Phone/Fax

Practice location:
  • Phone: 623-879-6034
  • Fax: 623-879-8164
Mailing address:
  • Phone: 623-879-6034
  • Fax: 623-879-8164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number1376
License Number StateAZ

VIII. Authorized Official

Name: DR. JERRY ALAN OLSHAN
Title or Position: PRESIDENT/PHYSICIAN
Credential: D.O.
Phone: 623-879-6034