Healthcare Provider Details

I. General information

NPI: 1962464586
Provider Name (Legal Business Name): RADIATION ONCOLOGY ASSOCIATES MEDICAL GROUP, INC. DBA. ONCOLOGY CARE P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 N FRESNO ST
FRESNO CA
93720-2950
US

IV. Provider business mailing address

PO BOX 28911
FRESNO CA
93729-8911
US

V. Phone/Fax

Practice location:
  • Phone: 559-447-4050
  • Fax:
Mailing address:
  • Phone: 559-228-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberG45487
License Number StateCA

VIII. Authorized Official

Name: MR. BRENT L. KANE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 559-447-4050