Organization
EL PASO RADIATION MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE ELKIN ELLERIN M.D. (PRESIDENT)
(856) 685-0114
Entity
Organization
Contact information
Practice address
1401 W EXPRESSWAY 83, SAN BENITO CANCER CENTER, SAN BENITO, TX 78586-7770
(856) 685-0114
Mailing address
224 COBBLE CREEK CIR, CHERRY HILL, NJ 08003-1838
(856) 685-0114
Taxonomy
Speciality
Code
Description
License number
State
2085R0203X
Therapeutic Radiology Physician
Primary
L8679
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z153
MEDICARE PTAN
TX
Enumeration date
10/17/2007
Last updated
12/08/2008
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