Basic Information
| Provider Information | |||||||||
| NPI: | 1285833863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAGNOSTIC & MEDICAL ONCOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 SPRING HILL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514351200 | ||||||||
| FaxNumber: | 2514356357 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 SPRING HILL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366041407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514351200 | ||||||||
| FaxNumber: | 2514356357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | SANDERS | ||||||||
| AuthorizedOfficialFirstName: | R | ||||||||
| AuthorizedOfficialMiddleName: | BARRE | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2514351200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | 26622 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.