Organization
COASTAL RADIATION ONCOLOGY ASSOC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE GENTRY TRIPP M.D. (PRESIDENT)
(912) 554-2100
Entity
Organization
Contact information
Practice address
2500 STARLING ST STE 107, BRUNSWICK, GA 31520-4266
(912) 466-5100
(912) 466-5113
Mailing address
2301 PARKWOOD DR, BRUNSWICK, GA 31520-4720
(912) 554-2100
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
028910
GA
Other
Enumeration date
03/04/2008
Last updated
03/04/2008
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