Healthcare Provider Details

I. General information

NPI: 1639163231
Provider Name (Legal Business Name): LUBBOCK GYNECOLOGIC ONCOLOGY ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 22ND ST SUITE 100
LUBBOCK TX
79410-1301
US

IV. Provider business mailing address

3621 22ND ST SUITE 100
LUBBOCK TX
79410-1301
US

V. Phone/Fax

Practice location:
  • Phone: 806-796-1317
  • Fax: 806-796-0426
Mailing address:
  • Phone: 806-796-1317
  • Fax: 806-796-0426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARY PHILLIPS
Title or Position: ADMINISTRATOR
Credential: BBA
Phone: 806-796-1317