Provider Demographics
NPI:1316944655
Name:TEXAS CANCER CLINIC PA
Entity type:Organization
Organization Name:TEXAS CANCER CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PRESTIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-247-0888
Mailing Address - Street 1:9102 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1553
Mailing Address - Country:US
Mailing Address - Phone:210-247-0888
Mailing Address - Fax:210-558-0758
Practice Address - Street 1:9102 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1553
Practice Address - Country:US
Practice Address - Phone:210-247-0888
Practice Address - Fax:210-558-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH88032085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00347XMedicare PIN