Basic Information
| Provider Information | |||||||||
| NPI: | 1366719213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA CANCER AFFILIATES PL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346551105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273729159 | ||||||||
| FaxNumber: | 7273768703 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346551105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273729159 | ||||||||
| FaxNumber: | 7273768703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2011 | ||||||||
| LastUpdateDate: | 05/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | ROBBINS | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7274847722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 004381500 | 05 | FL | MEDICAID | 265199800 | 05 | FL | MEDICAID |