Healthcare Provider Details

I. General information

NPI: 1770664542
Provider Name (Legal Business Name): SOUTH TEXAS ONCOLOGY AND HEMATOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4383 MEDICAL DRIVE
SAN ANTONIO TX
78229-3307
US

IV. Provider business mailing address

4383 MEDICAL DRIVE SUITE 4049
SAN ANTONIO TX
78229-3307
US

V. Phone/Fax

Practice location:
  • Phone: 210-593-2575
  • Fax: 210-593-5992
Mailing address:
  • Phone: 210-593-5700
  • Fax: 210-593-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LON S. SMITH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 210-593-5700