Provider Demographics
NPI:1154401685
Name:THIRD COAST RADIATION ONCOLOGY ASSOCIATION
Entity type:Organization
Organization Name:THIRD COAST RADIATION ONCOLOGY ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GARLITOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-887-4521
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78403-0188
Mailing Address - Country:US
Mailing Address - Phone:361-887-4521
Mailing Address - Fax:361-643-5366
Practice Address - Street 1:1415 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2105
Practice Address - Country:US
Practice Address - Phone:361-887-4521
Practice Address - Fax:361-643-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00744RMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER