Healthcare Provider Details

I. General information

NPI: 1710095302
Provider Name (Legal Business Name): CANCER CARE NETWORK OF SOUTH TEXAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W SCHUBERT ST
FREDERICKSBURG TX
78624-3847
US

IV. Provider business mailing address

100 NE LOOP 410 SUITE 600
SAN ANTONIO TX
78216-4700
US

V. Phone/Fax

Practice location:
  • Phone: 210-242-6541
  • Fax: 210-212-5136
Mailing address:
  • Phone: 210-242-6541
  • Fax: 210-212-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID H GORDON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-545-6972