Healthcare Provider Details

I. General information

NPI: 1447286745
Provider Name (Legal Business Name): RADIATION ONCOLOGY ASSOCIATES OF FT LAUDERDALE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY
FORT LAUDERDALE FL
33308-4603
US

IV. Provider business mailing address

4725 N FEDERAL HWY
FORT LAUDERDALE FL
33308-4603
US

V. Phone/Fax

Practice location:
  • Phone: 954-492-5764
  • Fax:
Mailing address:
  • Phone: 954-492-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME47189
License Number StateFL

VIII. Authorized Official

Name: DR. ABDON J MEDINA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 954-776-3016