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General NPI Number Information
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NPI Number | 1619136603
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Entity Type | Organization
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Legal Business Name | CANCER CARE NETWORK OF SOUTH TEXAS PA
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Dates
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Enumeration Date | 06/04/2008
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 11212 STATE HIGHWAY 151 BLDG 2, SUITE 120
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4498
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Country | US
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Telephone | 210-242-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 100 NE LOOP 410 SUITE 600
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City | SAN ANTONIO
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State | TX
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Zip | 78216-4700
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Country | US
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Telephone | 210-242-6541
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Fax | 210-212-5136
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID H GORDON
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Credential | M.D.
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Telephone | 210-618-8960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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