Organization
GULF COAST CANCER & DIAGNOSTIC CENTER AT SOUTHEAST
Active
Other names
University Diagnostic and Treatment Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MARK A DANDREA MD (OWNER)
(713) 474-1414
Entity
Organization
Contact information
Practice address
12811 BEAMER RD, HOUSTON, TX 77089-6140
(713) 474-1414
(713) 474-8477
Mailing address
PO BOX 7894, PASADENA, TX 77508-7894
(713) 474-1414
(713) 474-8477
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QX0203X
Radiation Oncology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0212DC
BLUE CROSS
TX
05
—
149577201
—
TX
Enumeration date
07/12/2005
Last updated
04/19/2016
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