Basic Information
| Provider Information | |||||||||
| NPI: | 1033544390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA PHYSICIAN SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7017 A C SKINNER PKWY | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322566932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045206800 | ||||||||
| FaxNumber: | 9045206801 | ||||||||
| Practice Location | |||||||||
| Address1: | 7017 A C SKINNER PKWY | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322566932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9045206800 | ||||||||
| FaxNumber: | 9045206801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2013 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | LUTZ | ||||||||
| AuthorizedOfficialFirstName: | MEAGHAN | ||||||||
| AuthorizedOfficialMiddleName: | COLLEEN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9045206800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.