Organization
CANCER SPECIALISTS OF SO TX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY COOPER (ADMINISTRATOR)
(361) 993-3456
Entity
Organization
Contact information
Practice address
1625 RODD FIELD RD, CORPUS CHRISTI, TX 78412-4926
(361) 993-3456
Mailing address
1625 RODD FIELD RD, CORPUS CHRISTI, TX 78412-4926
(361) 993-3456
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
D7369
TX
174400000X
Specialist
Primary
G8931
TX
174400000X
Specialist
L9212
TX
174400000X
Specialist
M1217
TX
207RH0003X
Hematology & Oncology Physician
D7369
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033804875
TRICARE PRIME
TX
05
—
116419601
—
TX
05
—
133216505
—
TX
01
—
152824210
TRICARE PRIME
TX
05
—
166693501
—
TX
05
—
175676901
—
TX
01
—
231964795
TRICARE PRIME DR NASH
TX
01
—
6543177
CIGNA DR NASH
TX
01
—
787700
FIRST HEALTH
TX
01
—
830002865
DR NASH RAILROAD MEDICARE
TX
01
—
P00150979
RAILROAD MEDICARE DR GONZ
TX
01
—
P00288207
DR MAHMOOD RAILROAD MEDIC
TX
Enumeration date
12/12/2006
Last updated
04/05/2011
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