Basic Information
| Provider Information | |||||||||
| NPI: | 1043263619 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEMATOLOGY ONCOLOGY ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 E BARNETT RD # E245 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418167039 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3011 E BARNETT RD | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417894673 | ||||||||
| FaxNumber: | 5417892121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 01/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | GILBERT | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5417745843 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 134384 | 05 | OR | MEDICAID |