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General NPI Number Information
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NPI Number | 1558446187
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Entity Type | Organization
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Legal Business Name | SAN JUAN ONCOLOGY ASSOCIATES, PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 2325 E 30TH ST
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City | FARMINGTON
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State | NM
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Zip | 87401-8900
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Country | US
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Telephone | 505-564-6850
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Fax | 505-564-6890
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Provider Business Mailing Address
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Address Line | 2325 E 30TH ST
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City | FARMINGTON
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State | NM
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Zip | 87401-8900
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Country | US
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Telephone | 505-564-6850
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Fax | 505-564-6890
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Authorized Official
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Title or Position | MD, CEO
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Name | JEFFREY D NEIDHART
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Credential | MD
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Telephone | 505-564-6850
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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