Organization
CANCER CARE NETWORK OF SOUTH TEXAS PA
Active
Other names
Fredericksburg-S.A.Tumor & Blood
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID H GORDON M.D. (PRESIDENT)
(210) 545-6972
Entity
Organization
Contact information
Practice address
204 W SCHUBERT ST, FREDERICKSBURG, TX 78624-3847
(210) 242-6541
(210) 212-5136
Mailing address
100 NE LOOP 410, SUITE 600, SAN ANTONIO, TX 78216-4700
(210) 242-6541
(210) 212-5136
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U40Q
BLUECROSS/BLUESHIELD TX
TX
05
—
109514302
—
TX
Enumeration date
08/25/2006
Last updated
10/20/2011
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