Healthcare Provider Details

I. General information

NPI: 1386112092
Provider Name (Legal Business Name): CANCER TREATMENT SPECIALIST, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

IV. Provider business mailing address

7500 E MCCORMICK PKWY LOT 32
SCOTTSDALE AZ
85258-2912
US

V. Phone/Fax

Practice location:
  • Phone: 808-442-5700
  • Fax: 808-442-5701
Mailing address:
  • Phone: 615-887-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DERRICK JEROME BEECH
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 615-887-1114