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Organization

EAST TEXAS RADIATION ONCOLOGY, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JAMES D KOLKER MD (PRESIDENT)
(903) 595-5550
Entity
Organization

Contact information

Practice address
721 CLINIC DR, TYLER, TX 75701-2043
(903) 595-5550
Mailing address
PO BOX 840059, DALLAS, TX 75284-0059
(903) 595-5550

Taxonomy

Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0029AE
BCBS GROUP NUMBER
TX
01
CE8872
RR MEDICARE
Enumeration date
08/15/2006
Last updated
10/16/2007
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