Healthcare Provider Details

I. General information

NPI: 1083150114
Provider Name (Legal Business Name): FUO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 3RD AVE W STE 210
BRADENTON FL
34205-8633
US

IV. Provider business mailing address

802 11TH ST W
BRADENTON FL
34205-7734
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-0340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. G AUSTIN HILL
Title or Position: CEO
Credential: MD
Phone: 941-704-7391