Healthcare Provider Details

I. General information

NPI: 1750373692
Provider Name (Legal Business Name): RADIATION ONCOLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 JEFFERSON LN NE
ALBUQUERQUE NM
87109-2127
US

IV. Provider business mailing address

4650 JEFFERSON LN NE
ALBUQUERQUE NM
87109-2127
US

V. Phone/Fax

Practice location:
  • Phone: 505-889-9639
  • Fax: 505-889-2978
Mailing address:
  • Phone: 505-889-9639
  • Fax: 505-889-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. DANIEL M PEARCE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 505-883-4542