Basic Information
| Provider Information | |||||||||
| NPI: | 1306928031 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC RADIATION ONCOLOGY CARE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5109 | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976010119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418821540 | ||||||||
| FaxNumber: | 5418822583 | ||||||||
| Practice Location | |||||||||
| Address1: | 2610 UHRMANN RD | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412744171 | ||||||||
| FaxNumber: | 5412744174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | KRAMER | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5412744171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.