Healthcare Provider Details

I. General information

NPI: 1265430136
Provider Name (Legal Business Name): ONCOLOGY PHYSICIANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 N MCMULLEN BOOTH RD SUITE 100
CLEARWATER FL
33761-2043
US

IV. Provider business mailing address

3253 N MCMULLEN BOOTH RD STE 100
CLEARWATER FL
33761-2043
US

V. Phone/Fax

Practice location:
  • Phone: 727-725-8102
  • Fax: 727-796-7009
Mailing address:
  • Phone: 727-725-8102
  • Fax: 727-796-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME34925
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLES ATHAN BROOKS
Title or Position: PRESIDENT
Credential: MD
Phone: 727-725-8102