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NPI Code Detail

MEDICARE: PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC

MEDICARE: PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC
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
1207RX0202XMedical Oncology PhysicianFL
22085R0001XRadiation Oncology PhysicianFL
32085R0202XDiagnostic Radiology PhysicianFL
4207U00000XNuclear Medicine PhysicianFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
133021OTHERFLBCBSFL

General Provider Information

NPI Number : 1770721466
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC
Provider Business Mailing Address
First Line : PO BOX 19633
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32245-9633
Country : US
Telephone Number : 904-346-3338
Fax Number : 904-346-0815
Provider Business Practice Location Address
First Line : 2003 CENTRE POINTE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4893
Country : US
Telephone Number : 850-878-2273
Fax Number : 850-671-5900
Authorized Official
Title or Position : PRESIDENT
Name : SHYAM B PARYANI
Credential : MD
Telephone Number : 904-346-3338
Provider Enumeration Date : 02/03/2009
Last Update Date : 08/06/2009

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Directions to “PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC ” Practice Location

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