Organization
SAN JUAN ONCOLOGY ASSOCIATES, PC
Active
Other names
FOUR CORNERS CANCER CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZA THURSON (BILLING SPECIALIST)
(505) 564-6871
Entity
Organization
Contact information
Practice address
1305 ESCALANTE DR STE 102-103, DURANGO, CO 81303-8931
(970) 335-9261
(970) 828-6890
Mailing address
PO BOX 1799, FARMINGTON, NM 87499-1799
(505) 564-6850
(505) 258-4959
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38022222
—
NM
05
—
46926534
—
NM
05
—
90124758
—
NM
05
—
97388866
—
NM
Enumeration date
07/19/2021
Last updated
07/19/2021
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