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General NPI Number Information
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NPI Number | 1194078790
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Entity Type | Organization
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Legal Business Name | PHOENIX ONCOLOGY OF TEXAS PLLC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 1304 WONDER WORLD DR
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City | SAN MARCOS
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State | TX
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Zip | 78666-7532
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Country | US
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Telephone | 512-396-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 WONDER WORLD DR
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City | SAN MARCOS
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State | TX
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Zip | 78666-7532
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Country | US
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Telephone | 512-396-2500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | J. MICHAEL KERLEY
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Credential | MD
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Telephone | 903-491-8470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | G3515
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | G3515
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License Number State | TX
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