Organization
PHOENIX ONCOLOGY LOST PINES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY MICHAEL KERLEY MD (OWNER)
(512) 303-5100
Entity
Organization
Contact information
Practice address
3107 HIGHWAY 71 E, BASTROP, TX 78602-5158
(512) 303-5100
(512) 303-5106
Mailing address
3107 HIGHWAY 71 E, BASTROP, TX 78602-5158
(512) 303-5100
(512) 303-5106
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
G3515
TX
Other
Enumeration date
08/30/2013
Last updated
08/30/2013
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