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General NPI Number Information
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NPI Number | 1316869746
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Entity Type | Organization
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Legal Business Name | CANYON CREST RADIATION ONCOLOGY PLLC
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 4931 VENTURE DRIVE
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City | PERU
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State | IL
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Zip | 61345
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Country | US
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Telephone | 779-345-2945
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Fax |
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Provider Business Mailing Address
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Address Line | 4931 VENTURE DRIVE
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City | PERU
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State | IL
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Zip | 61345
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. ROBERT THEODORE WOODBURN III
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Credential | MD
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Telephone | 219-741-1713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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