Basic Information
| Provider Information | |||||||||
| NPI: | 1851701239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLERMONT ONCOLOGY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1361 CITRUS TOWER BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522421366 | ||||||||
| FaxNumber: | 3522421372 | ||||||||
| Practice Location | |||||||||
| Address1: | 1361 CITRUS TOWER BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522421366 | ||||||||
| FaxNumber: | 3522421372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2014 | ||||||||
| LastUpdateDate: | 12/10/2014 | ||||||||
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| AuthorizedOfficialLastName: | KUNTA | ||||||||
| AuthorizedOfficialFirstName: | GOPAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9043050299 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | ME91372 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.