Healthcare Provider Details

I. General information

NPI: 1639579311
Provider Name (Legal Business Name): GYNECOLOGIC ONCOLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 08/29/2014
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:
Mailing address:
  • Phone: 806-796-1317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSEMARY P PHILLIPS
Title or Position: PRACTICE MANAGER
Credential: BBA
Phone: 806-796-1317