Organization
MOHAVE MEDICAL ONCOLOGY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE LINN KONIE (PRACTICE MANAGER)
(702) 471-7779
Entity
Organization
Contact information
Practice address
3801 SANTA ROSA, SUITE 200, KINGMAN, AZ 86401-2311
(702) 471-7779
(702) 471-0484
Mailing address
PO BOX 777550, HENDERSON, NV 89077-7550
(702) 471-7779
(702) 471-0484
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD18958
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056037
—
AZ
Enumeration date
07/30/2007
Last updated
01/31/2012
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