MEDICARE: ST. JUDE INTERNATIONAL CANCER ASSOCIATES, P.A.

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	207RH0003X	Hematology & Oncology Physician	F9119	TX
2	207R00000X	Internal Medicine Physician	F9119	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D0509362	OTHER	TX	CLIA ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538156922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JUDE INTERNATIONAL CANCER ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	5959 GATEWAY BLVD W
Second Line	:	SUITE 120
City	:	EL PASO
State	:	TX
Zip	:	79925-3331
Country	:	US
Telephone Number	:	915-779-1716
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N OREGON ST
Second Line	:	SUITE 500
City	:	EL PASO
State	:	TX
Zip	:	79902-3351
Country	:	US
Telephone Number	:	915-544-8844
Fax Number	:	915-544-7650

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AMBROSE ABOUD
Credential	:	MD
Telephone Number	:	915-544-8844

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	02/03/2015

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