MEDICARE: MID FLORIDA RADIATION ONCOLOGY ASSO

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	207RH0003X	Hematology & Oncology Physician
2	261QX0203X	Radiation Oncology Clinic/Center

General Provider Information

NPI Number	:	1316127277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID FLORIDA RADIATION ONCOLOGY ASSO

Provider Business Mailing Address
First Line	:	4400 COUNTRY CLUB DR
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-7620
Country	:	US
Telephone Number	:	281-337-3423
Fax Number	:	281-337-2611

Provider Business Practice Location Address
First Line	:	1231 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4707
Country	:	US
Telephone Number	:	772-464-8121
Fax Number	:	772-460-5503

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD HARLAN WOODY III
Credential	:	M.D.,
Telephone Number	:	772-468-3222

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	04/01/2008

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