Healthcare Provider Details

I. General information

NPI: 1083153365
Provider Name (Legal Business Name): BAPTIST MD ANDERSON CANCER PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 OLD SAINT AUGUSTINE RD SUITE 2593
JACKSONVILLE FL
32258-7418
US

IV. Provider business mailing address

PO BOX 746654
ATLANTA GA
30374-6654
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-3993
  • Fax: 904-389-3994
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-393-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: LEEANN MENGEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-202-7300