Healthcare Provider Details

I. General information

NPI: 1932107331
Provider Name (Legal Business Name): EAST BAY MEDICAL ONCOLOGY-HEMATOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 DALLAS RANCH RD
ANTIOCH CA
94531-8811
US

IV. Provider business mailing address

4721 DALLAS RANCH ROAD
ANTIOCH CA
94531-8811
US

V. Phone/Fax

Practice location:
  • Phone: 925-778-0679
  • Fax: 925-778-3567
Mailing address:
  • Phone: 925-778-0679
  • Fax: 925-778-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA36088
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN T GANEY
Title or Position: PARTNER
Credential: M.D.
Phone: 925-687-2570