Provider Demographics
NPI:1962419804
Name:SOUTHEAST TEXAS ONCOLOGY PARTNERS
Entity type:Organization
Organization Name:SOUTHEAST TEXAS ONCOLOGY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:BALTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:2811-440-5224
Mailing Address - Street 1:1140 CYPRESS STATION DRIVE
Mailing Address - Street 2:STE 302
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3002
Mailing Address - Country:US
Mailing Address - Phone:281-440-5224
Mailing Address - Fax:281-444-0933
Practice Address - Street 1:1140 CYPRESS STATION DRIVE
Practice Address - Street 2:STE 302
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3002
Practice Address - Country:US
Practice Address - Phone:281-440-5224
Practice Address - Fax:281-444-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045602201Medicaid
TX154680601Medicaid
TX099964102Medicaid
TX045602201Medicaid
C13119Medicare UPIN
H65452Medicare UPIN
00525KMedicare ID - Type Unspecified