MEDICARE: LONE STAR CANCER & BLOOD DISORDER, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1467479154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR CANCER & BLOOD DISORDER, PA

Provider Business Mailing Address
First Line	:	PO BOX 781905
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78278-1905
Country	:	US
Telephone Number	:	210-227-6156
Fax Number	:	210-527-1446

Provider Business Practice Location Address
First Line	:	925 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4643
Country	:	US
Telephone Number	:	210-227-6156
Fax Number	:	210-527-1446

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. DEVEN BHACHAWAT
Credential	:	MD
Telephone Number	:	210-227-6156

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	12/12/2013

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