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General NPI Number Information
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NPI Number | 1508926080
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Entity Type | Organization
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Legal Business Name | CANCER SPECIALISTS OF SO TX
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 1625 RODD FIELD RD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78412-4926
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Country | US
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Telephone | 361-993-3456
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 RODD FIELD RD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78412-4926
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Country | US
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Telephone | 361-993-3456
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIMBERLY COOPER
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Credential |
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Telephone | 361-993-3456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D7369
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L9212
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M1217
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | D7369
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G8931
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License Number State | TX
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