Healthcare Provider Details

I. General information

NPI: 1366411795
Provider Name (Legal Business Name): EDGARDO M SAYOC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CHESTER BLVD
RICHMOND IN
47374-1908
US

IV. Provider business mailing address

PO BOX 26706 SECTION #104
OKLAHOMA CITY OK
73126-0706
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3033
  • Fax: 765-983-3044
Mailing address:
  • Phone: 765-983-3033
  • Fax: 765-983-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number01026033A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: