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General NPI Number Information
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NPI Number | 1447486717
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Entity Type | Organization
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Legal Business Name | MEDICINE & RADIATION ONCOLOGY, PA
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 1010 NW LOOP 410 SUITE 100-D
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2220
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Country | US
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Telephone | 210-308-9999
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Fax | 210-308-6262
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Provider Business Mailing Address
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Address Line | 1010 NW LOOP 410 SUITE 100-D
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2220
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Country | US
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Telephone | 210-308-9999
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Fax | 210-308-6262
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. SURESH V DUTTA
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Credential | MD
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Telephone | 210-308-9999
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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 | L1024
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License Number State | TX
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