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General NPI Number Information
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NPI Number | 1023011491
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Entity Type | Organization
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Legal Business Name | TYLER HEMATOLOGY ONCOLOGY, P.A.
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 721 CLINIC DR STE A
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City | TYLER
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State | TX
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Zip | 75701-2043
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Country | US
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Telephone | 903-592-6152
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Fax | 903-526-0629
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Provider Business Mailing Address
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Address Line | 721 CLINIC DR STE A
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City | TYLER
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State | TX
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Zip | 75701-2043
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Country | US
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Telephone | 903-592-6152
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Fax | 903-526-0629
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FRED ERNEST
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Credential |
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Telephone | 903-593-8264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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