# GULF COAST CANCER & DIAGNOSTIC CENTER AT SOUTHEAST

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- **Entity:** Organization
- **Status:** Active
- **Other names:** University Diagnostic and Treatment Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194723296
- **Authorized official:** MARK A DANDREA MD (OWNER)
- **Authorized official phone:** (713) 474-1414

## Contact information

- **Practice address:** 12811 BEAMER RD, HOUSTON, TX 77089-6140
- **Practice address phone:** (713) 474-1414
- **Practice address fax:** (713) 474-8477
- **Mailing address:** PO BOX 7894, PASADENA, TX 77508-7894
- **Mailing address phone:** (713) 474-1414
- **Mailing address fax:** (713) 474-8477

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QX0203X | Radiation Oncology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/12/2005
- **Last updated:** 04/19/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0212DC | BLUE CROSS | TX |
| 05 | — | 149577201 | — | TX |