Basic Information
| Provider Information | |||||||||
| NPI: | 1730296229 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATION ONCOLOGY CENTERS OF SOUTHWEST FLORIDA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1450 | ||||||||
| Address2: | NW 5469 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554855469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417952270 | ||||||||
| FaxNumber: | 9417957995 | ||||||||
| Practice Location | |||||||||
| Address1: | 6215 21ST AVE W | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342097819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417952270 | ||||||||
| FaxNumber: | 9417957995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | TRI | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9417952270 | ||||||||
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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 | L06000059070 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.