Provider Demographics
NPI:1972541076
Name:GULF COAST ONCOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:GULF COAST ONCOLOGY ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'ANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-579-0061
Mailing Address - Street 1:PO BOX 7894
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-7894
Mailing Address - Country:US
Mailing Address - Phone:281-579-0061
Mailing Address - Fax:281-579-0093
Practice Address - Street 1:12811 BEAMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6140
Practice Address - Country:US
Practice Address - Phone:281-579-0061
Practice Address - Fax:281-579-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0049HWOtherBLUE CROSS
TX149949301Medicaid
TX149949301Medicaid