Healthcare Provider Details

I. General information

NPI: 1831622299
Provider Name (Legal Business Name): AMERICAN ONCOLOGY NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 FORUM CORPORATE PKWY SUITE 350
FORT MYERS FL
33905-7805
US

IV. Provider business mailing address

9160 FORUM CORPORATE PKWY SUITE 350
FORT MYERS FL
33905-7805
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-8502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE ORMAN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 239-274-8200