BLOOD AND CANCER CENTER OF EAST TEXAS PA (NPI# 1417954751) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417954751 |
| Entity Type | Organization |
| Organization Name | BLOOD AND CANCER CENTER OF EAST TEXAS PA |
| Practice Address |
825 Medical Dr Tyler TX 75701-2143 |
| Practice Telephone | 9035972273 |
| Practice Fax Number | 9035972466 |
| Mailing Telephone | 9035972273 |
| Mailing Fax Number | 9035972466 |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2010-07-15 |
| Authorized Official Name | GARY EDWARD GROSS (OWNER) |
| Authorized Official Telephone | 9035972273 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
207RH0003X | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 156974101 | 05 |
| Street Address |
825 MEDICAL DR |
| City | TYLER |
| State | TX |
| Zip Code | 75701-2143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821095266 | Charles Daniel Haas | Internal Medicine | 825 Medical Dr, Tyler, TX 75701-2143 | 2005-06-30 |
| 1982198057 | Special Health Resources for Texas Incorporated | Clinic/Center | 825 Medical Dr, Tyler, TX 75701-2143 | 2018-06-21 |
| 1891288742 | Carin Lynnae Wallace | Nurse Practitioner | 825 Medical Dr, Tyler, TX 75701-2143 | 2018-06-14 |
| 1013950997 | Ralph James Turner | Obstetrics & Gynecology | 825 Medical Dr, Tyler, TX 75701-2143 | 2006-06-14 |
| 1194722231 | Rene Lunday Mccarty | Physician Assistant | 825 Medical Dr, Tyler, TX 75701-2143 | 2005-07-05 |
| 1427055870 | Patricia E Lane | Nurse Practitioner | 825 Medical Dr, Tyler, TX 75701-2143 | 2005-06-30 |
| 1033116439 | Gary Edward Gross | Internal Medicine | 825 Medical Dr, Tyler, TX 75701-2143 | 2005-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851335442 | Svetislava Judith Vukelja | Internal Medicine | 910 East Houston Street, Tyler, TX 75702 | 2006-06-15 |
| 1821095266 | Charles Daniel Haas | Internal Medicine | 825 Medical Dr, Tyler, TX 75701-2143 | 2005-06-30 |
| 1023011491 | Tyler Hematology Oncology, P.a. | Internal Medicine | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2005-05-31 |
| 1952504045 | Marc Edward Usrey | Internal Medicine | 721 Clinic Dr, Suite A, Tyler, TX 75701-2043 | 2007-06-07 |
| 1144248501 | Katrina Y. Glover | Internal Medicine | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2006-07-17 |
| 1023056553 | Frank T Ward | Internal Medicine | 910 E Houston St, Tyler, TX 75702-8369 | 2006-06-04 |
| 1033116439 | Gary Edward Gross | Internal Medicine | 825 Medical Dr, Tyler, TX 75701-2143 | 2005-06-30 |
| 1407852700 | Joseph Todd Martins | Internal Medicine | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2005-06-22 |
| 1679578389 | Arielle S. Lee | Internal Medicine | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2005-06-17 |
| 1649275355 | Michael Y Ashigbi | Internal Medicine | 721 Clinic Dr, Ste A, Tyler, TX 75701-2043 | 2005-06-17 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.