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General NPI Number Information
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NPI Number | 1396898672
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Entity Type | Organization
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Legal Business Name | PENINSULA RADIATION ONCOLOGY SPECIALISTS
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2365 HOLMAN HIGHWAY CHOMP RADIATION ONCOLOGY
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City | MONTEREY
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State | CA
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Zip | 93942
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Country | US
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Telephone | 831-625-4630
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Fax | 831-625-4635
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Provider Business Mailing Address
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Address Line | PO BOX HH CHOMP RADIATION ONCOLOGY
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City | MONTEREY
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State | CA
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Zip | 93942-6032
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Country | US
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Telephone | 831-625-4630
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Fax | 831-625-4635
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | NEAL T GLOVER
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Credential | MD
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Telephone | 831-625-4630
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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 | G069630
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License Number State | CA
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