Healthcare Provider Details

I. General information

NPI: 1093961286
Provider Name (Legal Business Name): RADIATION THERAPY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SE STRATUS AVE
MCMINNVILLE OR
97128-6255
US

IV. Provider business mailing address

PO BOX 391
SALEM OR
97308-0391
US

V. Phone/Fax

Practice location:
  • Phone: 503-435-6590
  • Fax:
Mailing address:
  • Phone: 503-561-5135
  • Fax: 503-561-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW S GORDON
Title or Position: PARTNER
Credential: MD
Phone: 503-561-5135