Provider Demographics
NPI:1427069368
Name:DESERT HEMATOLOGY-ONCOLOGY MEDICAL GROUP INC
Entity type:Organization
Organization Name:DESERT HEMATOLOGY-ONCOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:BRIEN
Authorized Official - Last Name:DREISBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-568-3613
Mailing Address - Street 1:34490 BOB HOPE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-0000
Mailing Address - Country:US
Mailing Address - Phone:760-568-3613
Mailing Address - Fax:760-340-5189
Practice Address - Street 1:34490 BOB HOPE DRIVE
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-0000
Practice Address - Country:US
Practice Address - Phone:760-568-3613
Practice Address - Fax:760-340-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090020Medicaid
CACS3839OtherMEDICARE RAILROAD
CAZZZ80854ZMedicare PIN
CA0234450001Medicare NSC