Provider Demographics
NPI:1194078790
Name:PHOENIX ONCOLOGY OF TEXAS PLLC
Entity type:Organization
Organization Name:PHOENIX ONCOLOGY OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-491-8470
Mailing Address - Street 1:1304 WONDER WORLD DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7532
Mailing Address - Country:US
Mailing Address - Phone:512-396-2500
Mailing Address - Fax:
Practice Address - Street 1:1304 WONDER WORLD DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7532
Practice Address - Country:US
Practice Address - Phone:512-396-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3515207RX0202X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty