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Texas Cancer Registry (TCR)
Cancer Reporting Registration

Reporting Entity Information

1.Type of Reporting Entity(Required.)
2.Name of Reporting Entity (Legal Business Name or Physician Name, if registering as individual physician):(Required.)

Please enter the applicable 10-digit identification number(s) below.
• Individual health care provider (e.g., a physician), enter your individual NPI number.
• Organizational health care provider (e.g., a physician group), enter your organizational NPI number.

3.Identification Numbers
Please enter the contact information of the person responsible for reporting duties below.
4.Primary Contact(Required.)
5.Mailing Address(Required.)
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