Provider Demographics
NPI:1336233980
Name:BCG ONCOLOGY, PC
Entity type:Organization
Organization Name:BCG ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-493-6626
Mailing Address - Street 1:PO BOX 55016
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85078-5016
Mailing Address - Country:US
Mailing Address - Phone:602-493-6626
Mailing Address - Fax:602-996-1383
Practice Address - Street 1:16620 N 40TH STREET
Practice Address - Street 2:SUITE E
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3357
Practice Address - Country:US
Practice Address - Phone:602-493-6626
Practice Address - Fax:602-996-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29562208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ597320Medicaid
AZ597320Medicaid
AZA72456Medicare UPIN