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Organization
EL PASO RADIATION MEDICINE, P.A.
Active
Organization
EL PASO RADIATION MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE ELKIN ELLERIN M.D. (PRESIDENT)
(856) 685-0114
Entity
Organization
Contact information
Practice address
1401 W EXPRESSWAY 83, SAN BENITO CANCER CENTER, SAN BENITO, TX 78586-7770
(856) 685-0114
Mailing address
224 COBBLE CREEK CIR, CHERRY HILL, NJ 08003-1838
(856) 685-0114
Taxonomy
Speciality
Code
Description
License number
State
2085R0203X
Therapeutic Radiology Physician
Primary
L8679
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z153
MEDICARE PTAN
TX
Enumeration date
10/17/2007
Last updated
12/08/2008
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