Organization
NACOGDOCHES HEMATOLOGY-ONCOLOGY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DYANESH BAPU G RAVINDRAN M.D (PRESIDENT)
(936) 559-5330
Entity
Organization
Contact information
Practice address
1225 N MOUND ST, NACOGDOCHES, TX 75961-4028
(936) 559-5330
(936) 559-7140
Mailing address
1225 N MOUND ST, NACOGDOCHES, TX 75961-4028
(936) 559-5330
(936) 559-7140
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
K4204
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062HW
BC/BS PROVIDER #
TX
05
—
152183301
—
TX
Enumeration date
07/30/2006
Last updated
07/30/2010
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