MEDICARE: SURGICAL ONCOLOGY ASSOCIATES OF SOUTH FLORIDA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38248	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134260573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL ONCOLOGY ASSOCIATES OF SOUTH FLORIDA INC

Provider Business Mailing Address
First Line	:	4000 HOLLYWOOD BLVD
Second Line	:	PRESIDENTIAL CIRCLE, SUITE 160 NORTH
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6751
Country	:	US
Telephone Number	:	954-986-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 HOLLYWOOD BLVD
Second Line	:	PRESIDENTIAL CIRCLE, SUITE 160 NORTH
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6751
Country	:	US
Telephone Number	:	954-986-6366
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT BRUCE DONOWAY
Credential	:	M.D
Telephone Number	:	954-986-6366

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	04/08/2014

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