Basic Information
| Provider Information | |||||||||
| NPI: | 1639510829 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCALA ONCOLOGY CENTER PL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FLORIDA CANCER AFFILIATES-TAMPA BAY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7324 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346545518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274847722 | ||||||||
| FaxNumber: | 7274847780 | ||||||||
| Practice Location | |||||||||
| Address1: | 11373 CORTEZ BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346135405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525974998 | ||||||||
| FaxNumber: | 3525966051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 12/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | HOCHMAN | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7273729159 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 265199804 | 05 | FL | MEDICAID |