MEDICARE: MEDICINE & RADIATION ONCOLOGY, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	L1024	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447486717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE & RADIATION ONCOLOGY, PA

Provider Business Mailing Address
First Line	:	1010 NW LOOP 410
Second Line	:	SUITE 100-D
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2220
Country	:	US
Telephone Number	:	210-308-9999
Fax Number	:	210-308-6262

Provider Business Practice Location Address
First Line	:	1010 NW LOOP 410
Second Line	:	SUITE 100-D
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2220
Country	:	US
Telephone Number	:	210-308-9999
Fax Number	:	210-308-6262

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. SURESH V DUTTA
Credential	:	MD
Telephone Number	:	210-308-9999

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	10/02/2015

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