Organization
RADIATION ONCOLOGY CENTRAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY V GRAHAM MD (OWNER)
(573) 364-3205
Entity
Organization
Contact information
Practice address
DEPT OF RADIATION ONCOLOGY, 1000 W 10TH STREET, ROLLA, MO 65401
(573) 364-3205
(573) 364-2341
Mailing address
PO BOX 78399, SAINT LOUIS, MO 63178-8399
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
R3M43
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208279513
—
MO
Enumeration date
02/02/2006
Last updated
03/31/2009
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