Individual
DR. SANJAY P OOMMEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 S HENDERSON ST STE 200, FORT WORTH, TX 76104-2154
(174) 131-5008
(817) 413-1499
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 437-9605
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
48004
MN
207RH0003X
Hematology & Oncology Physician
Primary
M0514
TX
207RX0202X
Medical Oncology Physician
M0514
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
166168802
—
TX
05
—
166168803
—
TX
05
—
166168804
—
TX
01
—
8AQ001
BCBSTX
TX
05
—
926653000
—
MN
01
—
P00620588
RAILROAD MEDICARE
TX
Enumeration date
09/01/2006
Last updated
01/24/2023
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